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Individual

BENJAMIN EARLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
4430 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-9098
(573) 596-0035
Mailing address
198 B LYLE CURTIS CIRCLE, WAYNESVILLE, MO 65583

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
363A00000X
Physician Assistant
Primary

Other

Enumeration date
11/14/2019
Last updated
11/24/2019
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