Basic Information
| Provider Information | |||||||||
| NPI: | 1518005701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EAST | ||||||||
| FirstName: | NORMAN | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1075 N CURTIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083230031 | ||||||||
| FaxNumber: | 2083230064 | ||||||||
| Practice Location | |||||||||
| Address1: | 1075 N CURTIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083678333 | ||||||||
| FaxNumber: | 2083672003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 12/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | M-8258 | ID | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1102834 | 01 | ID | CIGNA MEDICARE | OTHER | 45898 | 01 | ID | BLUE CROSS | OTHER | 806139200 | 05 | ID | MEDICAID | P00063543 | 01 | ID | RR MEDICARE | OTHER | 000010034564 | 01 | ID | BLUE SHIELD | OTHER |