Provider Demographics
NPI:1487858304
Name:EASTMAN, AMY BRAZDA (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BRAZDA
Last Name:EASTMAN
Suffix:
Gender:F
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:3142 HORIZON RD STE 110
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7810
Practice Address - Country:US
Practice Address - Phone:972-771-3322
Practice Address - Fax:972-771-0272
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9174208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353314302Medicaid
TXP01932486OtherRAILROAD
BP1-0026519OtherINSTITUTIONAL PERMIT