Healthcare Provider Details

I. General information

NPI: 1144218876
Provider Name (Legal Business Name): IRA GORDON EARLY JR. M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 BOILING SPRINGS RD
SPARTANBURG SC
29303-2258
US

IV. Provider business mailing address

1241 BOILING SPRINGS RD
SPARTANBURG SC
29303-2258
US

V. Phone/Fax

Practice location:
  • Phone: 864-591-0992
  • Fax: 864-591-0776
Mailing address:
  • Phone: 864-591-0992
  • Fax: 864-591-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18944
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number18944
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number18944
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: