MEDICARE: OLIVER PERRY EARLE IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	23082	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57-1004971003	OTHER	SC	BCBS OF SC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7540519	OTHER	SC	AETNA

General Provider Information

NPI Number	:	1275576449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER PERRY EARLE IV M.D.

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT
Second Line	:	SUITE 212
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4545
Country	:	US
Telephone Number	:	864-797-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 SOUTH CLEVELAND STREET
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-2492
Country	:	US
Telephone Number	:	864-271-1450
Fax Number	:	864-271-3914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/15/2013

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