Provider Demographics
NPI:1699717363
Name:MAES, EARL BLAIR (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:BLAIR
Last Name:MAES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 PARK CENTRAL E
Mailing Address - Street 2:STE 516
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-1334
Mailing Address - Country:US
Mailing Address - Phone:417-889-6102
Mailing Address - Fax:417-889-6289
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:COX MEDICAL CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-269-4056
Practice Address - Fax:417-269-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-03-22
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Provider Licenses
StateLicense IDTaxonomies
MO20060392292085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163434001Medicaid
MOP00397064OtherRRR MEDICARE
MO1256OtherBLUE
MO204456206Medicaid
MOP00397064OtherRRR MEDICARE
H73821Medicare UPIN