Provider Demographics
NPI:1225053960
Name:EASTON, GALE E (PA-C)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:E
Last Name:EASTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-4101
Mailing Address - Country:US
Mailing Address - Phone:517-787-8015
Mailing Address - Fax:517-787-5520
Practice Address - Street 1:3165 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-4101
Practice Address - Country:US
Practice Address - Phone:517-787-8015
Practice Address - Fax:517-787-5520
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601001831OtherPHYSICIAN ASSISTANT LICEN
MI5601001831OtherPHYSICIAN ASSISTANT LICEN
854631Medicare UPIN