Healthcare Provider Details

I. General information

NPI: 1376751040
Provider Name (Legal Business Name): JOSEPH THOMAS EARLY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 201
JACKSON MI
49201-1849
US

IV. Provider business mailing address

1100 E MICHIGAN AVE STE 201
JACKSON MI
49201-1849
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10004993A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109479
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009421-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010025
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01832
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: