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Individual

KEVIN EARLYWINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
40773 N IRONWOOD DR, SAN TAN VALLEY, AZ 85140-7002
(602) 714-1271
(480) 987-6566
Mailing address
1250 S CLEARVIEW AVE STE 100, MESA, AZ 85209-3378
(480) 988-9108
(480) 813-4460

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2140
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
501347
AZ
01
Z173812
MEDICARE PTAN
Enumeration date
02/22/2006
Last updated
04/22/2015
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