Provider Demographics
NPI:1730243445
Name:EASLEY, RONALD BYRON (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BYRON
Last Name:EASLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 ROBESON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5552
Mailing Address - Country:US
Mailing Address - Phone:910-609-1623
Mailing Address - Fax:910-321-6248
Practice Address - Street 1:101 ROBESON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5552
Practice Address - Country:US
Practice Address - Phone:910-609-1623
Practice Address - Fax:910-321-6248
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC057959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83614Medicare UPIN