Provider Demographics
NPI:1649262536
Name:KILBRIDE, EARL J JR (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:J
Last Name:KILBRIDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 JOLLYVILLE RD
Mailing Address - Street 2:STE 207
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4105
Mailing Address - Country:US
Mailing Address - Phone:512-856-1000
Mailing Address - Fax:512-856-4040
Practice Address - Street 1:11675 JOLLYVILLE RD
Practice Address - Street 2:STE 207
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4105
Practice Address - Country:US
Practice Address - Phone:512-856-1000
Practice Address - Fax:512-856-4040
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5043207XX0005X, 207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149814901Medicaid
TXCS4290OtherRAILROAD MEDICARE
TXCS4290OtherRAILROAD MEDICARE
H51486Medicare UPIN
TX149814901Medicaid