Provider Demographics
NPI:1982039582
Name:S. FOSTER EASLEY, DO. PC
Entity type:Organization
Organization Name:S. FOSTER EASLEY, DO. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:S.
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:602-973-8285
Mailing Address - Street 1:1530 W GLENDALE AVE
Mailing Address - Street 2:SUITE: 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8578
Mailing Address - Country:US
Mailing Address - Phone:602-973-8285
Mailing Address - Fax:602-973-8248
Practice Address - Street 1:7878 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4449
Practice Address - Country:US
Practice Address - Phone:602-308-7817
Practice Address - Fax:602-277-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty