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NPI Code Detail

MEDICARE: GARY DEAN EASTES M.D.

MEDICARE: GARY DEAN EASTES 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
1208800000XUrology PhysicianD8202TX
2174400000XSpecialistD8202TX
3208800000XUrology PhysicianDR-38516CO

Other Identifiers

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

General Provider Information

NPI Number : 1457338527
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY DEAN EASTES M.D.
Provider Business Mailing Address
First Line : 14269 RR 2338
Second Line :
City : GEORGETOWN
State : TX
Zip : 78633-4112
Country : US
Telephone Number : 254-371-1060
Fax Number : 254-288-8875
Provider Business Practice Location Address
First Line : 1801 16TH ST
Second Line :
City : GREELEY
State : CO
Zip : 80631-5154
Country : US
Telephone Number : 970-392-2026
Fax Number : 970-392-2027
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 03/11/2015

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