Individual
DEAN EASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 STYNER AVE, MOSCOW, ID 83843-9394
(208) 882-8369
(208) 882-1887
Mailing address
PO BOX 9583, MOSCOW, ID 83843-0177
(208) 882-8369
(208) 882-1887
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
5480
NV
2085R0202X
Diagnostic Radiology Physician
Primary
M-11414
ID
2085R0202X
Diagnostic Radiology Physician
MD60222657
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
152972
WC
NV
01
—
153102
WC
NV
01
—
NV4207
BCBS
NV
01
—
NV4884
BCBS
NV
Enumeration date
05/15/2006
Last updated
10/12/2011
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