Robert K. Eastlack MD Inc

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

A73162 Issued in CA

Legal business name

ROBERT K. EASTLACK MD INC

Practice address

5265 Amber View PT
San Diego, CA 92130-6933

Phone

(858) 361-1390

Fax

(858) 925-7227

NPI assigned

Jul 3, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Kenneth Eastlack, M.D.

Title

President/Ceo

Phone

(858) 361-1390

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246579200000",
    "number": "1821227463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5265 AMBER VIEW PT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306933",
            "telephone_number": "858-361-1390",
            "fax_number": "858-925-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5265 AMBER VIEW PT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921306933",
            "telephone_number": "858-361-1390",
            "fax_number": "858-925-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT K. EASTLACK MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-03",
        "last_updated": "2009-07-03",
        "status": "A",
        "authorized_official_last_name": "EASTLACK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "858-361-1390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A73162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093411900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopaedic Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.