Healthcare Provider Details

I. General information

NPI: 1104280957
Provider Name (Legal Business Name): BRENT EARLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4750
  • Fax:
Mailing address:
  • Phone: 202-715-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD049275
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberD0089884
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: