Provider Demographics
NPI:1003044108
Name:EARLE, BRIAN (RPSGT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:EARLE
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4270 NW 103RD DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1597
Mailing Address - Country:US
Mailing Address - Phone:954-752-3257
Mailing Address - Fax:954-369-5020
Practice Address - Street 1:4270 NW 103RD DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1597
Practice Address - Country:US
Practice Address - Phone:954-752-3257
Practice Address - Fax:954-369-5020
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13465247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other