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NPI Code Detail

MEDICARE: DR. SCOTT MICHAEL EASLEY M.D.

MEDICARE: DR. SCOTT MICHAEL EASLEY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207QS0010XSports Medicine (Family Medicine) PhysicianR4384TX
3207QS0010XSports Medicine (Family Medicine) Physician61879AZ

General Provider Information

NPI Number : 1194088658
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT MICHAEL EASLEY M.D.
Provider Business Mailing Address
First Line : PO BOX 33269
Second Line :
City : PHOENIX
State : AZ
Zip : 85067-3269
Country : US
Telephone Number : 602-406-4786
Fax Number : 916-636-4358
Provider Business Practice Location Address
First Line : 500 W THOMAS RD STE 800
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4217
Country : US
Telephone Number : 602-406-1234
Fax Number : 602-406-6368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2012
Last Update Date : 07/21/2022

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