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1609877505

NPI Code Detail

MEDICARE: DR. ROBERT ROYAL EASTMAN MD

MEDICARE: DR. ROBERT ROYAL EASTMAN MD

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	207P00000X	Emergency Medicine Physician	51402	AZ
2	207Q00000X	Family Medicine Physician	2021023620	MO
3	207Q00000X	Family Medicine Physician	39761-020	WI
4	207Q00000X	Family Medicine Physician	MD2015-0820	NM
5	208600000X	Surgery Physician	39761-020	WI
6	207P00000X	Emergency Medicine Physician	2021023620	MO

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	:	1609877505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ROYAL EASTMAN MD

Provider Business Mailing Address
First Line	:	1200 N BEAVER ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3118
Country	:	US
Telephone Number	:	928-213-6235
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 S CANDY LN
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4158
Country	:	US
Telephone Number	:	928-639-6172
Fax Number	:	928-639-6682

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	07/14/2021

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Directions to “ DR. ROBERT ROYAL EASTMAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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