Provider Demographics
NPI:1225119019
Name:DOWNEY, EARL COURTNEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:COURTNEY
Last Name:DOWNEY
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 1:241 N VINE ST
Mailing Address - Street 2:906E
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:241 N VINE ST APT 906E
Practice Address - Street 2:906E
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1926
Practice Address - Country:US
Practice Address - Phone:801-891-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT485979212052086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD3887Medicaid
IN01076184B.OtherPHYSICIAN LICENSE
METD151161OtherPHYSICIAN LICENSE
CAG45941OtherPHYSICIAN LICENSE