Individual
R JACK EASTHAM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 EAST HIGH STREET, SUITE A, CHARLOTTESVILLE, VA 22902-4848
(434) 817-2300
(434) 817-2306
Mailing address
1000 EAST HIGH STREET, SUITE A, CHARLOTTESVILLE, VA 22902-4848
(434) 817-2300
(434) 817-2306
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101020554
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014258
ANTHEM BC BS
VA
01
—
419580
SOUTHERN HEALTH
VA
05
—
6577725
—
VA
Enumeration date
04/20/2006
Last updated
07/08/2007
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