Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | R4384 | TX |
NPI | 1194088658 |
---|---|
Provider Name | Dr. Scott Michael Easley |
First Address | Corpus Chrsiti, TX 78411-2549 |
Second Address | Corpus Christi, TX 78411-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 03/06/2020 |