DOUGLAS A EASTHAM (NPI# 1760796395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760796395 |
| Entity Type | Individual |
| Full Name | DOUGLAS A EASTHAM |
| Credential | PA-C |
| Practice Address |
1301 S Koke Mill Rd Springfield IL 62711-9252 |
| Mailing Address |
317 Seven Springs Way Ste 101 Brentwood TN 37027-4576 |
| Practice Telephone | 2175479100 |
| Practice Fax Number | 2175479236 |
| Mailing Telephone | 6153709992 |
| Mailing Fax Number | 6153709665 |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2020-01-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | 4038 | TN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
4038 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
085003810 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085003810 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
4038 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 085003810 | 05 |
| Street Address |
1301 S KOKE MILL RD |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62711-9252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902892607 | D Gordon Allan | Orthopaedic Surgery | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2005-09-27 |
| 1558973461 | Charity E Williams | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-08-21 |
| 1811509821 | Christina Prefountain | Registered Nurse | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-08-20 |
| 1467061408 | Daniel S Rebeck | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-07-27 |
| 1245850767 | Zachary M Barnett | Physician Assistant | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-24 |
| 1356961908 | Jessica Brough | Physician Assistant | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-23 |
| 1013536093 | Molly L Morgan | Physical Therapist | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-04-10 |
| 1326670183 | Jeffery R Chambers | Nurse Practitioner | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-02-10 |
| 1225677396 | Carrie F Thornton | Registered Nurse | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2020-01-06 |
| 1730724972 | Lindsay Breanne Dixon | Nurse Practitioner | 1301 S Koke Mill Rd, Springfield, IL 62711-9252 | 2019-11-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578057220 | Merissa Pryor | Social Worker | 4200 Conestoga Drive, Mbn 120, Springfield, IL 62711 | 2018-06-17 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1841682424 | Americare At Centennial Pointe Assisted Living LLC | Assisted Living Facility | 3440 Hedley Road, Springfield, IL 62711 | 2015-02-19 |
| 1306249248 | Schon Dental, LLC | Dentist | 2809 Mansion Road Suite D, Springfield, IL 62711 | 2014-10-07 |
| 1891105490 | John Weiss | Pharmacist | 4200 Conestoga Drive, Springfield, IL 62711 | 2014-05-05 |
| 1720350689 | Victor Harold Lary | Family Medicine | 3251 Spaulding Orchard Road, Springfield, IL 62711 | 2012-02-07 |
| 1902181795 | Amanda Rose Davis | Pharmacist | 2500 Koke Mill Rd, Springfield, IL 62711 | 2011-10-12 |
| 1316233703 | Karen Zerkle | Dentist | 2809 Mansion Rd, Suite D, Springfield, IL 62711 | 2011-06-23 |
| 1255520557 | Link Chiropractic LLC | Chiropractor | 7012 Kingsmill Ct, Springfield, IL 62711 | 2007-10-23 |
| 1669688230 | Victoria Lynn Driskill | Dentist | 4701 W. Wabash Ave, Springfield, IL 62711 | 2007-05-14 |
| Find all providers in zip 62711 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871122168 | Alexandra Emmanuelle Rochman | Physician Assistant | 54 W Crystal Brook Dr, Springfield, MA 01118-1946 | 2020-04-07 |
| 1740740737 | Western New England University | Physician Assistant | 215 Wilbraham Road, Springfield, MA 01119 | 2019-03-25 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| 1770850216 | Lauren Jennifer Navas | Physician Assistant | 100 River St Ste 2, Springfield, VT 05156-2930 | 2011-11-29 |
| 1295885168 | Jacqueline Kernaghan | Physician Assistant | 723 Saxer Ave, Springfield, PA 19064-3503 | 2007-01-11 |
| 1295746733 | Gwen Wright | Physician Assistant | 194 W Sproul Rd, Suite 105, Springfield, PA 19064-2027 | 2006-08-10 |
| 1164490710 | Stacie L Pierce | Physician Assistant | 3721 W El Castile St, Springfield, MO 65807-5431 | 2006-03-09 |
| 1245206432 | Annette K Bates | Physician Assistant | 819 Worcester St Ste 3, Springfield, MA 01151-1056 | 2006-02-27 |
| 1518947159 | Louis Patrick Favata | Physician Assistant | 140 High St., Springfield, MA 01199 | 2006-01-19 |
| 1649257031 | Scott D Rubin | Physician Assistant | 3400 Main Street, Springfield, MA 01107-1113 | 2005-12-27 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62711 |
Please comment or provide details below to improve the information on DOUGLAS A EASTHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.