Provider Demographics
NPI:1134129976
Name:EASTERLING, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:EASTERLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3507
Mailing Address - Country:US
Mailing Address - Phone:941-379-6331
Mailing Address - Fax:941-379-5443
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-379-6331
Practice Address - Fax:941-379-5443
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059922174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE92983Medicare UPIN