Provider Demographics
NPI:1275588964
Name:EAST, WILLIAM ROBERT
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:EAST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MEDI-PARK
Mailing Address - Street 2:SUITE 6
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2105
Mailing Address - Country:US
Mailing Address - Phone:806-355-7421
Mailing Address - Fax:806-358-2381
Practice Address - Street 1:1901 MEDI-PARK
Practice Address - Street 2:SUITE 6
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2105
Practice Address - Country:US
Practice Address - Phone:806-355-7421
Practice Address - Fax:806-358-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2215207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034377401Medicaid
TX072417195OtherRAILROAD MEDICARE
TX112095100OtherFIRSTCARE HEALTH PLANS
TX00K398OtherBC/BS OF TEXAS
TX112095100OtherFIRSTCARE HEALTH PLANS
TX072417195OtherRAILROAD MEDICARE
TX034377401Medicaid