Provider Demographics
NPI:1710974092
Name:EARL, JEFFREY J (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:EARL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:11725 W 112TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2761
Practice Address - Country:US
Practice Address - Phone:913-469-5579
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0521081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E65133Medicare UPIN
5536782AMedicare ID - Type Unspecified