Provider Demographics
NPI:1235107715
Name:GEORGE L. EASTMAN III, M.D. P.A.
Entity type:Organization
Organization Name:GEORGE L. EASTMAN III, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-7101
Mailing Address - Street 1:3700 W 15TH ST
Mailing Address - Street 2:SUITE #130A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4736
Mailing Address - Country:US
Mailing Address - Phone:972-596-7101
Mailing Address - Fax:972-612-2031
Practice Address - Street 1:3700 W 15TH ST
Practice Address - Street 2:SUITE #130A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4736
Practice Address - Country:US
Practice Address - Phone:972-596-7101
Practice Address - Fax:972-612-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87674Medicare UPIN