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General NPI Number Information
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NPI Number | 1023150018
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Entity Type | Organization
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Legal Business Name | EARL PLASTIC SURGERY, P.C.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 653 N TOWN CENTER DR SUITE 108
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City | LAS VEGAS
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State | NV
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Zip | 89144-0514
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Country | US
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Telephone | 702-939-3436
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Fax | 702-939-3437
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Provider Business Mailing Address
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Address Line | 653 N TOWN CENTER DR SUITE 108
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City | LAS VEGAS
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State | NV
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Zip | 89144-0514
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Country | US
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Telephone | 702-939-3436
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Fax | 702-939-3437
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAMERON I EARL
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Credential | M.D.
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Telephone | 702-939-3436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 11812
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License Number State | NV
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