Healthcare Provider Details

I. General information

NPI: 1699760959
Provider Name (Legal Business Name): ALFRED DOUGLAS EARWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PARK AVE
BANNER ELK NC
28604-6604
US

IV. Provider business mailing address

PO BOX 1568
BANNER ELK NC
28604-1568
US

V. Phone/Fax

Practice location:
  • Phone: 828-898-5177
  • Fax: 828-898-8306
Mailing address:
  • Phone: 828-898-5177
  • Fax: 828-898-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33815
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: