Provider Demographics
NPI:1831246669
Name:EARL, JOSEPH B (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:EARL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 W THUNDERBIRD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6083
Mailing Address - Country:US
Mailing Address - Phone:623-878-5800
Mailing Address - Fax:623-878-5807
Practice Address - Street 1:7615 W THUNDERBIRD RD STE 105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6083
Practice Address - Country:US
Practice Address - Phone:623-878-5800
Practice Address - Fax:623-878-5807
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ173018Medicaid
AZ3592OtherSTATE LICENSE
AZZ113375Medicare PIN