Provider Demographics
NPI:1902219462
Name:EARLEY, JAMES PATRICK JR (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:EARLEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:PATRICK
Other - Last Name:EARLEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-7776
Mailing Address - Fax:224-610-7703
Practice Address - Street 1:87 ARGONAUT ROAD
Practice Address - Street 2:SUBMARINE READINESS SQUADRON 32 MEDICAL
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5000
Practice Address - Country:US
Practice Address - Phone:860-694-2783
Practice Address - Fax:860-694-4326
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102204643207R00000X
CT70648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN