MEDICARE: JEFFERY EASTERLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34802	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00238548	OTHER	TN	RR MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134165178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY EASTERLY MD

Provider Business Mailing Address
First Line	:	129 MONTGOMERY LN
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-5649
Country	:	US
Telephone Number	:	865-681-1224
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 MONTGOMERY LN
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-5649
Country	:	US
Telephone Number	:	865-681-1224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	03/24/2009

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Directions to “ JEFFERY EASTERLY MD” Practice Location

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