Provider Demographics
NPI:1932212560
Name:EASLEY, STEVEN W (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:EASLEY
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 1:217 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8976
Mailing Address - Country:US
Mailing Address - Phone:601-278-0938
Mailing Address - Fax:
Practice Address - Street 1:217 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8976
Practice Address - Country:US
Practice Address - Phone:601-278-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120900Medicaid
MS080003643Medicare ID - Type Unspecified
MSG92733Medicare UPIN