Provider Demographics
NPI:1396970539
Name:BAIN, EARL EUGENE III (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:EUGENE
Last Name:BAIN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:7200 CREEDMOOR RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1710
Mailing Address - Country:US
Mailing Address - Phone:919-518-0999
Mailing Address - Fax:919-518-0939
Practice Address - Street 1:7200 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1710
Practice Address - Country:US
Practice Address - Phone:919-518-0999
Practice Address - Fax:919-518-0939
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2014-09-19
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Provider Licenses
StateLicense IDTaxonomies
NY258454-1207ND0101X
AL32218207N00000X
NC2013-02484207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology