Provider Demographics
NPI:1902219462
Name:EARLEY, JAMES PATRICK JR (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:EARLEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:PATRICK
Other - Last Name:EARLEY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:6221 LAKE BADIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3337
Mailing Address - Country:US
Mailing Address - Phone:224-610-7776
Mailing Address - Fax:224-610-7703
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70648207R00000X, 207RC0000X
VA0102204643207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN