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NPI Code Detail

MEDICARE: DR. WILFRED WALTER EASTMAN JR. M.D/

MEDICARE:  DR. WILFRED WALTER EASTMAN JR. 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
1207X00000XOrthopaedic Surgery Physician00G396230CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3200018580OTHERCAMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CJ570ZOTHERCAPTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4CMS116890OTHERCAMTC CONSULTANT
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6CMS116890OTHERCACALIFORNIA CHILDREN'S SERVICES CCS

General Provider Information

NPI Number : 1437129939
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILFRED WALTER EASTMAN JR. M.D/
Provider Business Mailing Address
First Line : 444 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3450
Country : US
Telephone Number : 530-842-1267
Fax Number : 530-842-9121
Provider Business Practice Location Address
First Line : 475 BRUCE ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3474
Country : US
Telephone Number : 530-842-1267
Fax Number : 530-842-9121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 11/17/2009

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Directions to “ DR. WILFRED WALTER EASTMAN JR. M.D/” Practice Location

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