MEDICARE: EVAN EASTMAN

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	363A00000X	Physician Assistant	079011	IA

General Provider Information

NPI Number	:	1558744763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN EASTMAN

Provider Business Mailing Address
First Line	:	1843 LOWER MUSCATINE RD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3105
Country	:	US
Telephone Number	:	319-384-8822
Fax Number	:	319-354-1002

Provider Business Practice Location Address
First Line	:	1843 LOWER MUSCATINE RD
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-3105
Country	:	US
Telephone Number	:	319-384-8822
Fax Number	:	319-354-1002

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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Directions to “ EVAN EASTMAN ” Practice Location

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