Healthcare Provider Details

I. General information

NPI: 1982039582
Provider Name (Legal Business Name): S. FOSTER EASLEY, DO. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7878 N 16TH ST
PHOENIX AZ
85020-4449
US

IV. Provider business mailing address

1530 W GLENDALE AVE SUITE: 104
PHOENIX AZ
85021-8578
US

V. Phone/Fax

Practice location:
  • Phone: 602-308-7817
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-973-8285
  • Fax: 602-973-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3212
License Number StateAZ

VIII. Authorized Official

Name: MR. S. FOSTER EASLEY III
Title or Position: OWNER
Credential: DO
Phone: 602-973-8285