Provider Demographics
NPI:1750506986
Name:EARLE, ROBERT NELSON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NELSON
Last Name:EARLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:NELSON
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1002 GEMINI ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2746
Mailing Address - Country:US
Mailing Address - Phone:281-218-8181
Mailing Address - Fax:281-218-7676
Practice Address - Street 1:1002 GEMINI ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2746
Practice Address - Country:US
Practice Address - Phone:281-218-8181
Practice Address - Fax:281-218-7676
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK02912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX260051483OtherPALMETTO GPA RAIL ROAD MEDICARE
TX0016BWOtherBC/BS
TX113329004Medicaid
TX0016BWOtherBC/BS
TX260051483OtherPALMETTO GPA RAIL ROAD MEDICARE