Individual
MR. ISSAC DAWON EARLS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4502 MAGIN MEADOW DR, AUSTIN, TX 78744-5248
(512) 947-7875
Mailing address
4502 MAGIN MEADOW DR, AUSTIN, TX 78744-5248
(512) 947-7875
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EARL1278
—
TX
Enumeration date
06/06/2007
Last updated
07/08/2007
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