Provider Demographics
NPI:1790555449
Name:EASON, ZACHARY PHILLIP
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PHILLIP
Last Name:EASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 GERALD DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-9449
Mailing Address - Country:US
Mailing Address - Phone:931-334-3335
Mailing Address - Fax:
Practice Address - Street 1:3RD RECON BN, H&S, BAS
Practice Address - Street 2:36180
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96389-6180
Practice Address - Country:US
Practice Address - Phone:315-625-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman