Provider Demographics
NPI:1174554596
Name:EASLEY, THOMAS D (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51440
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1440
Mailing Address - Country:US
Mailing Address - Phone:806-355-9595
Mailing Address - Fax:806-353-1589
Practice Address - Street 1:7100 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1704
Practice Address - Country:US
Practice Address - Phone:806-355-9595
Practice Address - Fax:806-353-1589
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4102207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126337801Medicaid
TX126337803Medicaid
TXB22443Medicare UPIN
TX126337801Medicaid
TX126337803Medicaid