Healthcare Provider Details

I. General information

NPI: 1356329551
Provider Name (Legal Business Name): GUY H EARLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9226 BAYSHORE DR NW SUITE 230
SILVERDALE WA
98383-9196
US

IV. Provider business mailing address

9226 BAYSHORE DR NW SUITE 230
SILVERDALE WA
98383-9196
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-6202
  • Fax: 360-698-5808
Mailing address:
  • Phone: 360-692-6202
  • Fax: 360-698-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48805
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: