Provider Demographics
NPI:1821186511
Name:DR. DAVID EARL, MD INC. PS
Entity Type:Organization
Organization Name:DR. DAVID EARL, MD INC. PS
Other - Org Name:DR. DAVID EARL, MD INC PS
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-765-1538
Mailing Address - Street 1:1550 S PIONEER WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4613
Mailing Address - Country:US
Mailing Address - Phone:509-765-1538
Mailing Address - Fax:509-765-7508
Practice Address - Street 1:1550 S PIONEER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4613
Practice Address - Country:US
Practice Address - Phone:509-765-1538
Practice Address - Fax:509-765-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
WAMD00028611261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117575Medicaid
WA0174366OtherDEPT OF L&I
WA7117575Medicaid