Provider Demographics
NPI:1154385417
Name:EASLEY, KEVIN O (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:O
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12855 NORTH FORTY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-628-1210
Mailing Address - Fax:314-628-1220
Practice Address - Street 1:12855 NORTH FORTY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-628-1210
Practice Address - Fax:314-628-1220
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO105787207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
431787580OtherGREAT WEST
332932OtherHEALTHLINK
431787580OtherGOLDEN RULE
54920OtherCMR
C83613OtherMERCY
3605461OtherMEDICARE COMPLETE
MO431787580OtherUNITED HEALTHCARE
4915117001OtherCIGNA
54920OtherGROUP HEALTH PLAN
MO207950916Medicaid
MO110257OtherBCBS
P00007539OtherRR MEDICARE
MO110257OtherBCBS
MO207950916Medicaid