Provider Demographics
NPI:1235179003
Name:EARLEY, MITCHELL L (DO)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:EARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 W MEMORIAL RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2103
Mailing Address - Country:US
Mailing Address - Phone:405-491-4090
Mailing Address - Fax:405-491-4091
Practice Address - Street 1:6801 W MEMORIAL RD UNIT E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2103
Practice Address - Country:US
Practice Address - Phone:405-491-4090
Practice Address - Fax:405-491-4091
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39879207Q00000X
OK3849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC398796Medicaid
SC398796Medicaid
SCSC94219223Medicare PIN