Healthcare Provider Details

I. General information

NPI: 1538163159
Provider Name (Legal Business Name): DONALD EASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 INTERLOCHEN BLVD
WINTER HAVEN FL
33884-3707
US

IV. Provider business mailing address

1119 INTERLOCHEN BLVD
WINTER HAVEN FL
33884-3707
US

V. Phone/Fax

Practice location:
  • Phone: 863-289-6060
  • Fax:
Mailing address:
  • Phone: 863-289-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0059921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: