Provider Demographics
NPI:1407807266
Name:EASTON, DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:EASTON
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:PO BOX 9583
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-0177
Mailing Address - Country:US
Mailing Address - Phone:208-882-8369
Mailing Address - Fax:208-882-1887
Practice Address - Street 1:405 STYNER AVE
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9394
Practice Address - Country:US
Practice Address - Phone:208-882-8369
Practice Address - Fax:208-882-1887
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54802085R0202X
IDM-114142085R0202X
WAMD602226572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV4207OtherBCBS
NVNV4884OtherBCBS
NV152972OtherWC
NV153102OtherWC
NVV30WCHKB08Medicare PIN
NVNV4207OtherBCBS
NVNV4884OtherBCBS
C95910Medicare UPIN
NV153102OtherWC
NVV30WCCBG1DMedicare PIN
ID1196466Medicare PIN