MEDICARE: DR. RICK GORDON EASTIN M.D.

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	208D00000X	General Practice Physician	G34898	CA

General Provider Information

NPI Number	:	1376841999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICK GORDON EASTIN M.D.

Provider Business Mailing Address
First Line	:	1471 LAS BRISAS DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-6717
Country	:	US
Telephone Number	:	831-265-7323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 LAS BRISAS DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-6717
Country	:	US
Telephone Number	:	831-265-7323
Fax Number	:

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

Provider Enumeration Date	:	03/06/2011
Last Update Date	:	03/06/2011

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