Provider Demographics
NPI:1841397718
Name:EASTON, MATTHEW JAMES (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:EASTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:P.O. BOX 427
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-4264
Mailing Address - Fax:559-299-1421
Practice Address - Street 1:445 11TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE COVE
Practice Address - State:CA
Practice Address - Zip Code:93646-2211
Practice Address - Country:US
Practice Address - Phone:559-626-4031
Practice Address - Fax:559-626-4963
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A79460Medicare ID - Type Unspecified
CAI05268Medicare UPIN