=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205811130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EARL FRITZ BRAUNLICH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 PLAZA DR
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-695-1474
-----------------------------------------------------
Fax | 740-695-1817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 PLAZA DR
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-695-1474
-----------------------------------------------------
Fax | 740-695-1817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 22872
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 22872
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 22872
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 35.094820
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 35.094820
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------