Provider Demographics
NPI:1063175263
Name:EASTWOOD, JEFFREY STEVEN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:STEVEN
Last Name:EASTWOOD
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 1:2ND MARDIV, 2ND RECON
Mailing Address - Street 2:PSC BOX 20138
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2ND MARDIV, 2ND RECON BATTALION
Practice Address - Street 2:SNEADS FERRY RD BLDG A71
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-440-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman