Organization
SURFSIDE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARRY ALLEN EARLE M.D. (DOCTOR)
(321) 799-2554
Entity
Organization
Contact information
Practice address
3000 N ATLANTIC AVE, SUITE 108, COCOA BEACH, FL 32931-5078
(321) 799-2554
(321) 799-4750
Mailing address
3000 N ATLANTIC AVE, SUITE 108, COCOA BEACH, FL 32931-5078
(321) 799-2554
(321) 799-4750
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME00059920
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055552599
—
FL
01
—
AG997
MEDICARE PTAN
FL
Enumeration date
10/04/2007
Last updated
04/22/2008
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