Provider Demographics
NPI:1295732139
Name:EASTMAN, PAUL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:EASTMAN
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 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3796
Mailing Address - Country:US
Mailing Address - Phone:712-277-3141
Mailing Address - Fax:712-277-2645
Practice Address - Street 1:2730 PIERCE ST STE 201
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3764
Practice Address - Country:US
Practice Address - Phone:712-277-3141
Practice Address - Fax:712-277-2645
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3874207V00000X
IA29940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1295732139Medicaid
P01203005OtherMEDICARE PTAN RAILROAD
SD1295732139Medicaid
IB2715004OtherMEDICARE PTAN
NE1295732139Medicaid
IB2715004OtherMEDICARE PTAN
SD4998006Medicaid
IA12328Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER