Provider Demographics
NPI:1992929590
Name:EASON, ROSS W
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:W
Last Name:EASON
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 1:412 VENUS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6303
Mailing Address - Country:US
Mailing Address - Phone:956-682-4398
Mailing Address - Fax:
Practice Address - Street 1:1340 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4914
Practice Address - Country:US
Practice Address - Phone:214-743-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator