Provider Demographics
NPI:1477521599
Name:EASTMAN, GEORGE LEONARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEONARD
Last Name:EASTMAN
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4001 W 15TH ST STE 350
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5863
Practice Address - Country:US
Practice Address - Phone:972-596-1111
Practice Address - Fax:972-612-2031
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD7022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87674Medicare UPIN