Provider Demographics
NPI:1700871613
Name:EASTERDAY, DAVID EVERETT (DO)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EVERETT
Last Name:EASTERDAY
Suffix:
Gender:M
Credentials:DO
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 249
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0249
Mailing Address - Country:US
Mailing Address - Phone:636-528-6755
Mailing Address - Fax:636-528-6965
Practice Address - Street 1:1003 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1503
Practice Address - Country:US
Practice Address - Phone:636-528-6755
Practice Address - Fax:636-528-6965
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243764107Medicaid
MOG86173Medicare UPIN
MO243764107Medicaid