Individual
JEDIDIAH A EARLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
911 BIG COVE RD SE, HUNTSVILLE, AL 35801-3750
(256) 265-8120
(256) 265-8969
Mailing address
PO BOX 1389, HUNTSVILLE, AL 35807-0389
(256) 265-8120
(256) 265-8969
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-100539
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003085168
TRICARE STANDARD
AL
05
—
100722
—
AL
01
—
515-47214
BC BS OF ALABAMA
AL
01
—
P00825733
RAILROAD MEDICARE
AL
Enumeration date
02/22/2008
Last updated
06/29/2010
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