Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F3917 | TX |
N | 207XS0117X | Orthopaedic Spine Surgeon | F3917 | TX |
NPI | 1013914498 |
---|---|
Provider Name | Stephen Edward Earle |
First Address | San Antonio, TX 78265-3577 |
Second Address | Live Oak, TX 78233-3277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 06/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033081302 | (05) | TX |
169383001 | (05) | TX |
201626736 | TAX ID # (01) | TX |
602044900 | U.S. DOL # (01) | TX |
B22437 | (02) | TX |