Individual
DANIEL EASTLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7600 WOLF RIVER BLVD STE 200, GERMANTOWN, TN 38138-1788
(901) 747-1000
Mailing address
7600 WOLF RIVER BLVD STE 200, GERMANTOWN, TN 38138-1788
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42401
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2016
Last updated
01/24/2023
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