Provider Demographics
NPI:1467414201
Name:EASTON, DIANA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:EASTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 E STATE HIGHWAY 260
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4959
Mailing Address - Country:US
Mailing Address - Phone:928-472-9480
Mailing Address - Fax:928-472-6176
Practice Address - Street 1:708 E STATE HIGHWAY 260
Practice Address - Street 2:SUITE B-1
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4959
Practice Address - Country:US
Practice Address - Phone:928-472-9480
Practice Address - Fax:928-472-6176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0868940OtherBLUE CROSS PIN
AZAZ0868940OtherBLUE CROSS PIN
Z106969Medicare ID - Type Unspecified