Provider Demographics
NPI:1942383724
Name:EASTMAN, ANN R (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:R
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3035
Mailing Address - Country:US
Mailing Address - Phone:806-687-7284
Mailing Address - Fax:806-687-7255
Practice Address - Street 1:410 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3035
Practice Address - Country:US
Practice Address - Phone:806-771-2018
Practice Address - Fax:806-771-2078
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0741207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891789BMedicaid
GA000891789BMedicaid
GAH33655Medicare UPIN