Provider Demographics
NPI:1417243031
Name:EAVES, DAVID (PA,)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EAVES
Suffix:
Gender:M
Credentials:PA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 S. HIGH ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-3616
Mailing Address - Country:US
Mailing Address - Phone:614-748-2000
Mailing Address - Fax:614-784-3000
Practice Address - Street 1:2912 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-3616
Practice Address - Country:US
Practice Address - Phone:614-748-2000
Practice Address - Fax:614-784-3000
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant