Basic Information
| Provider Information | |||||||||
| NPI: | 1982039582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S. FOSTER EASLEY, DO. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 W GLENDALE AVE | ||||||||
| Address2: | SUITE: 104 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850218578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029738285 | ||||||||
| FaxNumber: | 6029738248 | ||||||||
| Practice Location | |||||||||
| Address1: | 7878 N 16TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850204449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023087817 | ||||||||
| FaxNumber: | 6022778146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | EASLEY | ||||||||
| AuthorizedOfficialFirstName: | S. | ||||||||
| AuthorizedOfficialMiddleName: | FOSTER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6029738285 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3212 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.