Basic Information
| Provider Information | |||||||||
| NPI: | 1609877505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EASTMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ROYAL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N BEAVER ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860013118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282136235 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 269 S CANDY LN | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863264158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286396172 | ||||||||
| FaxNumber: | 9286396682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 51402 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 2021023620 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 39761-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2015-0820 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 208600000X | 39761-020 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 2021023620 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 32433200 | 05 | WI | MEDICAID |