Healthcare Provider Details

I. General information

NPI: 1407852213
Provider Name (Legal Business Name): SUSIE EARLY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 NORTH KEENE STREET SUITE 401
COLUMBIA MO
65201
US

IV. Provider business mailing address

303 NORTH KEENE STREET SUITE 401
COLUMBIA MO
65201
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-6984
  • Fax: 573-874-8737
Mailing address:
  • Phone: 573-874-6984
  • Fax: 573-874-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DR. ELIZABETH K. EARLY
Title or Position: PHYSICIAN
Credential: MD
Phone: 573-874-6984