Provider Demographics
NPI:1588832943
Name:STEPHEN E. EARLE M.D. P.A.
Entity Type:Organization
Organization Name:STEPHEN E. EARLE M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-872-6572
Mailing Address - Street 1:PO BOX 33577
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-3577
Mailing Address - Country:US
Mailing Address - Phone:210-872-6572
Mailing Address - Fax:210-651-5137
Practice Address - Street 1:12315 JUDSON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3277
Practice Address - Country:US
Practice Address - Phone:210-872-6572
Practice Address - Fax:210-651-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3917207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22347Medicare UPIN
00601XMedicare PIN