Provider Demographics
NPI:1588623706
Name:EAST, JOHN W (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:EAST
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:16633 DALLAS PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6816
Mailing Address - Country:US
Mailing Address - Phone:972-380-0000
Mailing Address - Fax:972-380-0030
Practice Address - Street 1:16633 DALLAS PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6816
Practice Address - Country:US
Practice Address - Phone:972-380-0000
Practice Address - Fax:972-380-0042
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-06-10
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Provider Licenses
StateLicense IDTaxonomies
TXK7724208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031373602Medicaid
TX031373602Medicaid
H22982Medicare UPIN