Provider Demographics
NPI:1518005701
Name:EAST, NORMAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JOHN
Last Name:EAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1075 N CURTIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1300
Mailing Address - Country:US
Mailing Address - Phone:208-323-0031
Mailing Address - Fax:208-323-0064
Practice Address - Street 1:1075 N CURTIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-367-8333
Practice Address - Fax:208-367-2003
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8258207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1102834OtherCIGNA MEDICARE
ID45898OtherBLUE CROSS
ID806139200Medicaid
IDP00063543OtherRR MEDICARE
ID000010034564OtherBLUE SHIELD
ID45898OtherBLUE CROSS
1102834Medicare PIN