Healthcare Provider Details

I. General information

NPI: 1023125887
Provider Name (Legal Business Name): NATHANIEL LEROY EASTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 W THOMAS RD STE 325
PHOENIX AZ
85037-3396
US

IV. Provider business mailing address

2320 N 3RD ST
PHOENIX AZ
85004-1303
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-5406
  • Fax: 623-936-5479
Mailing address:
  • Phone: 602-258-9900
  • Fax: 602-258-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5780
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: