Provider Demographics
NPI:1376303883
Name:EASTMAN, BENJAMIN PAUL
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PAUL
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 QUAIL HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5138
Mailing Address - Country:US
Mailing Address - Phone:712-251-7229
Mailing Address - Fax:
Practice Address - Street 1:985 QUAIL HOLLOW CIR
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5138
Practice Address - Country:US
Practice Address - Phone:712-251-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-11965208000000X
MO2024024806208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics