MEDICARE: BILLY LEE EARL

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	229N00000X	Anaplastologist

General Provider Information

NPI Number	:	1457893547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY LEE EARL

Provider Business Mailing Address
First Line	:	2525 N DECATUR BLVD STE 2&3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2975
Country	:	US
Telephone Number	:	702-982-3636
Fax Number	:	702-982-3737

Provider Business Practice Location Address
First Line	:	2525 N DECATUR BLVD STE 2&3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2975
Country	:	US
Telephone Number	:	702-982-3636
Fax Number	:	702-982-3737

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

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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Directions to “ BILLY LEE EARL ” Practice Location

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