Provider Demographics
NPI:1528095882
Name:EARTHMAN, BRIAN S (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:EARTHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 W. PARMER LN. ST. 310
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-528-9498
Mailing Address - Fax:
Practice Address - Street 1:11901 W PARMER LN
Practice Address - Street 2:STE 310
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7654
Practice Address - Country:US
Practice Address - Phone:512-528-9498
Practice Address - Fax:512-843-7164
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL53162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174507501Medicaid
TX00739YMedicare ID - Type UnspecifiedGROUP #