Healthcare Provider Details

I. General information

NPI: 1942267299
Provider Name (Legal Business Name): LAWRENCE STEPHEN EASTBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FORT ST
NEAH BAY WA
98357-4003
US

IV. Provider business mailing address

PO BOX 410
NEAH BAY WA
98357-0410
US

V. Phone/Fax

Practice location:
  • Phone: 360-645-2233
  • Fax:
Mailing address:
  • Phone: 360-645-2233
  • Fax: 360-645-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00037646
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: