Provider Demographics
NPI:1053599944
Name:BRIAN S. EARTHMAN MD PA
Entity type:Organization
Organization Name:BRIAN S. EARTHMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:EARTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-535-0775
Mailing Address - Street 1:11901 W. PARMER LANE
Mailing Address - Street 2:SUITE 310
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 LANE
Practice Address - Street 2:SUITE 310
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-528-9498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL53162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00739YMedicare PIN