Healthcare Provider Details

I. General information

NPI: 1821186511
Provider Name (Legal Business Name): DR. DAVID EARL, MD INC. PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S PIONEER WAY SUITE 200
MOSES LAKE WA
98837-4613
US

IV. Provider business mailing address

1550 S PIONEER WAY SUITE 200
MOSES LAKE WA
98837-4613
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-1538
  • Fax: 509-765-7508
Mailing address:
  • Phone: 509-765-1538
  • Fax: 509-765-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00028611
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID EARL
Title or Position: MD
Credential: MD
Phone: 509-765-1538