Provider Demographics
NPI:1568456549
Name:BRAUNLIN, EARL ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:ALBERT
Last Name:BRAUNLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:717 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-4002
Mailing Address - Country:US
Mailing Address - Phone:260-426-3494
Mailing Address - Fax:260-426-3495
Practice Address - Street 1:717 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-4002
Practice Address - Country:US
Practice Address - Phone:260-426-3494
Practice Address - Fax:260-426-3495
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2008-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018005A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0646100001Medicare NSC
IN139040Medicare PIN
D95736Medicare UPIN