MEDICARE: DR. TIMOTHY MARC EASTIN 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
1	207T00000X	Neurological Surgery Physician	E-18339	AR

General Provider Information

NPI Number	:	1568994960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MARC EASTIN M.D.

Provider Business Mailing Address
First Line	:	2708 S RIFE MEDICAL LN STE 140
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1455
Country	:	US
Telephone Number	:	479-338-3720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 S RIFE MEDICAL LN STE 140
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-1455
Country	:	US
Telephone Number	:	479-338-3720
Fax Number	:

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	07/29/2024

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