Individual
DR. KEVIN O EASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12855 NORTH FORTY DR, SUITE 200, ST LOUIS, MO 63141
(314) 628-1210
(314) 628-1220
Mailing address
12855 NORTH FORTY DR, SUITE 200, ST LOUIS, MO 63141
(314) 628-1210
(314) 628-1220
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
105787
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110257
BCBS
MO
05
—
207950916
—
MO
01
—
332932
HEALTHLINK
—
01
—
3605461
MEDICARE COMPLETE
—
01
—
431787580
UNITED HEALTHCARE
MO
01
—
431787580
GREAT WEST
—
01
—
4915117001
CIGNA
—
01
—
54920
CMR
—
01
—
C83613
MERCY
—
01
—
P00007539
RR MEDICARE
—
Enumeration date
04/13/2006
Last updated
07/02/2008
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