Provider Demographics
NPI:1962408492
Name:EARLY, ELIZABETH K 'SUSIE' (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:K 'SUSIE'
Last Name:EARLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:303 N KEENE ST STE 401
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8054
Practice Address - Country:US
Practice Address - Phone:573-884-2200
Practice Address - Fax:573-884-8836
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2003015142207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO661525OtherHEALTHLINK
MO190084OtherBLUE CROSS BLUE SHIELD
MO200777146OtherTRICARE
MO209173301Medicaid
MO48602OtherHEALTHCARE USA
MOP00132117OtherRAILROAD MEDICARE
MO918864221Medicare PIN
MO661525OtherHEALTHLINK