Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD22875 | OR |
Y | 208600000X | Surgeon | MD22875 | OR |
N | 2086S0129X | Vascular Surgeon | MD22875 | OR |
NPI | 1144301300 |
---|---|
Provider Name | Dr. Mark Adalbert Eaton |
First Address | Medford, OR 97504-4316 |
Second Address | Medford, OR 97504-4316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 23/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109130 | MEDICARE (01) | OR |
287578 | (05) | OR |
4898012 | BLUE CROSS (01) | OR |
H33522 | (02) | OR |