Provider Demographics
NPI:1235131020
Name:EASTER, THOMAS GLENN II (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GLENN
Last Name:EASTER
Suffix:II
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 1:6938 ALTO REY AVE
Mailing Address - Street 2:STE 1003
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3059
Mailing Address - Country:US
Mailing Address - Phone:915-227-5545
Mailing Address - Fax:915-584-1299
Practice Address - Street 1:2931 MONTANA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2409
Practice Address - Country:US
Practice Address - Phone:915-562-4246
Practice Address - Fax:915-564-0667
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7801208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00681405OtherMEDICARE RR
TX135303909Medicaid
B87673Medicare UPIN
TXP00681405OtherMEDICARE RR