Provider Demographics
NPI:1265477541
Name:DR. ROBERT W. EATON, PC
Entity Type:Organization
Organization Name:DR. ROBERT W. EATON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-339-2499
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515058OtherBLUE CROSS BLUE SHIELD
AL51515058OtherBLUE CROSS BLUE SHIELD