Healthcare Provider Details

I. General information

NPI: 1841397718
Provider Name (Legal Business Name): MATTHEW JAMES EASTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 11TH ST
ORANGE COVE CA
93646-2211
US

IV. Provider business mailing address

2740 HERNDON AVE P.O. BOX 427
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-626-4031
  • Fax: 559-626-4963
Mailing address:
  • Phone: 559-299-4264
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: