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General NPI Number Information
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NPI Number | 1457730236
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Entity Type | Organization
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Legal Business Name | EASLEY JAMES D
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 4712 FM 1094
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City | SEALY
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State | TX
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Zip | 77474
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Country | US
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Telephone | 979-885-2767
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Fax | 979-885-2767
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Provider Business Mailing Address
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Address Line | PO BOX 1239
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City | SEALY
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State | TX
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Zip | 77474-1239
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Country | US
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Telephone | 979-885-2767
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Fax | 979-885-2767
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Authorized Official
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Title or Position | PRIVATE PRACTICE
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Name | DR. JAMES DAVID EASLEY
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Credential | MD
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Telephone | 979-885-2767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D8697
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | D8697
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License Number State | TX
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