Healthcare Provider Details

I. General information

NPI: 1104820620
Provider Name (Legal Business Name): J HAMILTON EASTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S QUEEN ST
DOVER DE
19904-3567
US

IV. Provider business mailing address

720 S QUEEN ST
DOVER DE
19904-3567
US

V. Phone/Fax

Practice location:
  • Phone: 302-735-8705
  • Fax: 302-735-8703
Mailing address:
  • Phone: 302-735-8705
  • Fax: 302-735-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC10002873
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: