Basic Information
| Provider Information | |||||||||
| NPI: | 1366552218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EASTERLING | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828854268 | ||||||||
| FaxNumber: | 6828857956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | H9626 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10032461 | 01 | TX | AMERIGROUP PIN | OTHER | 4301822 | 01 | TX | AETNA PIN | OTHER | 82Y892 | 01 | TX | BCBSTX IND PIN | OTHER | 1392703 | 01 | TX | UHC PIN | OTHER | 6414914 | 01 | TX | CIGNA PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 112097100 | 01 | TX | FIRSTCARE PIN | OTHER | 129718605 | 05 | TX | MEDICAID | 129718606 | 01 | TX | CSHCN | OTHER | 124132 | 01 | TX | SUPERIOR PIN | OTHER | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 87143 | 01 | TX | PHCS PIN | OTHER | 1727198 | 01 | TX | FIRSTHEALTH PIN | OTHER |