Provider Demographics
NPI:1952419129
Name:METCALF, EARL R (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:R
Last Name:METCALF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10499 COUNTY ROAD 605
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-8501
Mailing Address - Country:US
Mailing Address - Phone:573-624-8160
Mailing Address - Fax:
Practice Address - Street 1:1429 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-335-9175
Practice Address - Fax:573-334-3390
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO064034367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104407OtherHEALTH ALLIANCE
MO248460OtherHEALTHLINK
MO112188OtherBCBS
MOP00181240OtherRAILROAD MEDICARE