Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | D61589 | MD |
NPI | 1003857632 |
---|---|
Provider Name | Ronald Easley |
First Address | Baltimore, MD 21264-4382 |
Second Address | Houston, TX 77030-2316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 28/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
405323100 | (05) | MD |
I14179 | (02) | MD |