MEDICARE: DR. EMORY LEVON EASTIN 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	29390	SC
2	207V00000X	Obstetrics & Gynecology Physician	04-50625	KS
3	207V00000X	Obstetrics & Gynecology Physician	J4095	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00387008G	OTHER	GA	MEDICARE RAILROAD PTAN#
2	P00708630	OTHER	SC	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1861475402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMORY LEVON EASTIN M.D.

Provider Business Mailing Address
First Line	:	5928 RICHWATER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5332
Country	:	US
Telephone Number	:	864-431-2786
Fax Number	:

Provider Business Practice Location Address
First Line	:	5928 RICHWATER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5332
Country	:	US
Telephone Number	:	864-431-2786
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	06/21/2026

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Directions to “ DR. EMORY LEVON EASTIN M.D.” Practice Location

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