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NPI Code Detail

MEDICARE: GEORGE RICHARD EASON D.P.M.

MEDICARE:   GEORGE RICHARD EASON  D.P.M.
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
1213E00000XPodiatrist102804-0501UT

General Provider Information

NPI Number : 1649244872
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE RICHARD EASON D.P.M.
Provider Business Mailing Address
First Line : 2269 BONAZA COURT
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8903
Country : US
Telephone Number : 801-750-0258
Fax Number :
Provider Business Practice Location Address
First Line : 2269 BONANZA COURT
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-8903
Country : US
Telephone Number : 801-750-0258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2006
Last Update Date : 09/04/2009

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Directions to “ GEORGE RICHARD EASON D.P.M.” Practice Location

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