Provider Demographics
NPI:1821025867
Name:EASON, WILLIAM ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
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 1:270 E COURT AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2304
Mailing Address - Country:US
Mailing Address - Phone:731-645-7932
Mailing Address - Fax:731-645-5195
Practice Address - Street 1:270 E COURT AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2304
Practice Address - Country:US
Practice Address - Phone:731-645-7932
Practice Address - Fax:731-645-5195
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN115569Medicaid
TN3124134OtherBLUE CROSS BLUE SHIELD A
TN12096Medicaid
TN3124135OtherBLUE CROSS BLUE SHIELD H
TN3123018OtherBLUE CROSS BLUE SHIELD S
TN3717101Medicaid
TN3123018OtherBLUE CROSS BLUE SHIELD S
E54857Medicare UPIN
080091902Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3124135OtherBLUE CROSS BLUE SHIELD H
TN3124134OtherBLUE CROSS BLUE SHIELD A