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Organization

WESTERN IDAHO PATHOLOGY PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOSEPH R EASTMAN III MD (PRESIDENT)
(208) 455-3799
Entity
Organization

Contact information

Practice address
1717 ARLINGTON AVE, CALDWELL, ID 83605-4802
(208) 455-3799
(310) 698-7040
Mailing address
PO BOX 49009, GREENWOOD, SC 29649-0001
(864) 223-3070
(864) 223-1396

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8078528
ID
Enumeration date
09/24/2007
Last updated
10/22/2008
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