Provider Demographics
NPI:1134122567
Name:EARL, GENE M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:M
Last Name:EARL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9477
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-9477
Mailing Address - Country:US
Mailing Address - Phone:903-594-2450
Mailing Address - Fax:
Practice Address - Street 1:1100 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3301
Practice Address - Country:US
Practice Address - Phone:903-595-5025
Practice Address - Fax:903-595-0548
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X1632OtherBLUE CROSS
TXP00404431OtherRAILROAD MEDICARE
TXB87663Medicare UPIN
TX00N022Medicare PIN
TXP00404431OtherRAILROAD MEDICARE
TXP00404431Medicare PIN