Individual
DR. S FOSTER EASLEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1530 W. GLENDALE AVE., SUITE 104, PHOENIX, AZ 85021
(602) 973-8285
(602) 973-8248
Mailing address
1530 W. GLENDALE AVE, SUITE 104, PHOENIX, AZ 85021
(602) 973-8285
(602) 973-8248
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3212
AZ
207QA0401X
Addiction Medicine (Family Medicine) Physician
3212
AZ
207RA0401X
Addiction Medicine (Internal Medicine) Physician
3212
AZ
207RI0200X
Infectious Disease Physician
3212
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
579170
—
AZ
Enumeration date
06/15/2006
Last updated
01/08/2014
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