Provider Demographics
NPI:1508115080
Name:RICHARD EASON DPM PC
Entity Type:Organization
Organization Name:RICHARD EASON DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-750-0258
Mailing Address - Street 1:2269 W BONANZA CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8903
Mailing Address - Country:US
Mailing Address - Phone:801-750-0258
Mailing Address - Fax:801-302-9363
Practice Address - Street 1:2269 W BONANZA CT
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8903
Practice Address - Country:US
Practice Address - Phone:801-750-0258
Practice Address - Fax:801-302-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty