Provider Demographics
NPI:1417052861
Name:EASTIN, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:EASTIN
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 1:6921 HICKMAN RD # 2327
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4805
Mailing Address - Country:US
Mailing Address - Phone:515-270-2242
Mailing Address - Fax:515-271-6311
Practice Address - Street 1:6921 HICKMAN RD # 2327
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4805
Practice Address - Country:US
Practice Address - Phone:515-271-6300
Practice Address - Fax:515-271-6311
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA355082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19944OtherWELLMARK
IA0432674Medicaid
IA19944OtherWELLMARK
IAF00114Medicare UPIN