Provider Demographics
NPI:1942267299
Name:EASTBURN, LAWRENCE STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:EASTBURN
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 1:801 W 5TH AVE
Mailing Address - Street 2:STE 317
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2823
Mailing Address - Country:US
Mailing Address - Phone:509-747-0845
Mailing Address - Fax:509-747-0492
Practice Address - Street 1:801 W 5TH AVE
Practice Address - Street 2:STE 317
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2823
Practice Address - Country:US
Practice Address - Phone:509-747-0845
Practice Address - Fax:509-747-0492
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8253726Medicaid
WA911216033OtherTAX ID
WAH19217OtherSTERLING OPTION ONE
WA0143577OtherLABOR & INDUSTRIES
WAP00222485OtherMEDICARE RAILROAD
WA000010149422OtherREGENCE BLUE SHIELD OF ID
WA4409EAOtherASURIS NORTHWEST
WAKY985OtherBLUE CROSS OF ID
WA202124409OtherTRICARE
WAH19217Medicare UPIN
WA8253726Medicaid