MEDICARE: DR. PAUL JOSEPH EASTMAN 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
1	207V00000X	Obstetrics & Gynecology Physician	3874	SD
2	207V00000X	Obstetrics & Gynecology Physician	29940	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01203005	OTHER		MEDICARE PTAN RAILROAD
4	IB2715004	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295732139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JOSEPH EASTMAN M.D.

Provider Business Mailing Address
First Line	:	2730 PIERCE ST
Second Line	:	SUITE 201
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3796
Country	:	US
Telephone Number	:	712-277-3141
Fax Number	:	712-277-2645

Provider Business Practice Location Address
First Line	:	2730 PIERCE ST STE 201
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3764
Country	:	US
Telephone Number	:	712-277-3141
Fax Number	:	712-277-2645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/18/2022

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Directions to “ DR. PAUL JOSEPH EASTMAN M.D.” Practice Location

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