Provider Demographics
NPI:1609055128
Name:WILLIAM R. EAST MD, P.A.
Entity Type:Organization
Organization Name:WILLIAM R. EAST MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-355-7421
Mailing Address - Street 1:5211 W 9TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4149
Mailing Address - Country:US
Mailing Address - Phone:806-355-7421
Mailing Address - Fax:806-358-2381
Practice Address - Street 1:5211 W 9TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4149
Practice Address - Country:US
Practice Address - Phone:806-355-7421
Practice Address - Fax:806-358-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2215207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5561Medicare PIN