MEDICARE: MR. JOHN W EAST DO

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	208100000X	Physical Medicine & Rehabilitation Physician	K7724	TX
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	K7724	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1588623706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN W EAST DO

Provider Business Mailing Address
First Line	:	16633 DALLAS PKWY
Second Line	:	SUITE 150
City	:	ADDISON
State	:	TX
Zip	:	75001-6816
Country	:	US
Telephone Number	:	972-380-0000
Fax Number	:	972-380-0030

Provider Business Practice Location Address
First Line	:	16633 DALLAS PKWY
Second Line	:	SUITE 150
City	:	ADDISON
State	:	TX
Zip	:	75001-6816
Country	:	US
Telephone Number	:	972-380-0000
Fax Number	:	972-380-0042

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	06/10/2016

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Directions to “ MR. JOHN W EAST DO” Practice Location

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