MEDICARE: RICHARD EASON DPM PC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1508115080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD EASON DPM PC

Provider Business Mailing Address
First Line	:	2269 W BONANZA CT
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8903
Country	:	US
Telephone Number	:	801-750-0258
Fax Number	:	801-302-9363

Provider Business Practice Location Address
First Line	:	2269 W BONANZA CT
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-8903
Country	:	US
Telephone Number	:	801-750-0258
Fax Number	:	801-302-9363

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. RICHARD EASON
Credential	:	D.P.M.
Telephone Number	:	801-750-0258

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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