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NPI Code Detail

MEDICARE: MR. ERIC STENER EASTMO MD

MEDICARE: MR. ERIC STENER EASTMO 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
12085R0001XRadiation Oncology Physician5447SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437144102
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC STENER EASTMO MD
Provider Business Mailing Address
First Line : PO BOX 8010
Second Line : 353 FAIRMONT BLVD
City : RAPID CITY
State : SD
Zip : 57709-8010
Country : US
Telephone Number : 605-719-8559
Fax Number : 605-719-2310
Provider Business Practice Location Address
First Line : 353 FAIRMONT BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-7375
Country : US
Telephone Number : 605-719-8559
Fax Number : 605-719-2310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 09/27/2012

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Directions to “ MR. ERIC STENER EASTMO MD” Practice Location

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