Individual
DR. JASON P EASTLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1519 MARION ST, COLUMBIA, SC 29201-2910
(803) 296-5954
(803) 296-3076
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8614
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
24394
MS
2085R0202X
Diagnostic Radiology Physician
Primary
52431
SC
2085R0202X
Diagnostic Radiology Physician
P2434
TX
Other
Enumeration date
06/14/2010
Last updated
11/11/2020
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