Provider Demographics
NPI:1073513479
Name:EATON, ROBERT W (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:EATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5004 HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-2039
Mailing Address - Country:US
Mailing Address - Phone:205-339-2499
Mailing Address - Fax:205-339-6422
Practice Address - Street 1:5004 HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-2039
Practice Address - Country:US
Practice Address - Phone:205-339-2499
Practice Address - Fax:205-339-6422
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD0441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515058OtherBLUE CROSS BLUE SHIELD
AL051515058Medicare PIN