Provider Demographics
NPI:1215913132
Name:EARLY, GARY MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:EARLY
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1 CROWN DR
Mailing Address - Street 2:SUTIE 200 P O BOX R
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2510
Mailing Address - Country:US
Mailing Address - Phone:660-665-2844
Mailing Address - Fax:660-665-0130
Practice Address - Street 1:COMPLETE FAMILY MEDICINE
Practice Address - Street 2:1 CROWN DRIVE, SUITE 200
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:660-665-2844
Practice Address - Fax:660-665-0130
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-10-26
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Provider Licenses
StateLicense IDTaxonomies
MOR5B64207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241527142Medicaid