Provider Demographics
NPI:1619062585
Name:EASON, CARL P (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:EASON
Suffix:
Gender:M
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 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:395 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1642
Practice Address - Country:US
Practice Address - Phone:386-496-3211
Practice Address - Fax:386-496-1599
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53187208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048070301Medicaid
FL05734AMedicare ID - Type Unspecified
FL048070301Medicaid