Provider Demographics
NPI:1144218876
Name:EARLY, IRA GORDON JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:GORDON
Last Name:EARLY
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2258
Mailing Address - Country:US
Mailing Address - Phone:864-591-0992
Mailing Address - Fax:864-591-0776
Practice Address - Street 1:1241 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2258
Practice Address - Country:US
Practice Address - Phone:864-591-0992
Practice Address - Fax:864-591-0776
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18944207Q00000X, 2083T0002X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDC0005OtherMEDICARE RAILROAD GROUP
SCT29993Medicaid
SCP00141794OtherMEDICARE RAILROAD PIN
SCDC0005OtherMEDICARE RAILROAD GROUP
SCE403938101Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER