Provider Demographics
NPI:1386823029
Name:EASTMAN, JONATHAN GARLAND (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GARLAND
Last Name:EASTMAN
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 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-6998
Mailing Address - Fax:
Practice Address - Street 1:6414 FANNIN ST STE G150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1514
Practice Address - Country:US
Practice Address - Phone:713-486-7560
Practice Address - Fax:713-486-7512
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60208128207X00000X, 207XX0801X
CAA00102556207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0280066OtherL&I
WA1386823029Medicaid
WA8901579Medicare PIN