Provider Demographics
NPI:1699762120
Name:EASTMAN, PATRICIA J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 W 42ND ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-0615
Mailing Address - Country:US
Mailing Address - Phone:308-630-2906
Mailing Address - Fax:308-632-6181
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-0615
Practice Address - Country:US
Practice Address - Phone:308-630-2906
Practice Address - Fax:308-632-6181
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE157512085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB68005Medicare UPIN
NE087886Medicare PIN