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Individual
R JACK EASTHAM
Active
Individual
R JACK EASTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101020554
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014258
ANTHEM BC BS
VA
01
—
419580
SOUTHERN HEALTH
VA
05
—
6577725
—
VA
Enumeration date
04/20/2006
Last updated
07/13/2026
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