Basic Information
| Provider Information | |||||||||
| NPI: | 1972522803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EARLEY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 E DIXIE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523508888 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E DIXIE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523508888 | ||||||||
| FaxNumber: | 8443886186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS 11295 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO3953 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.