Provider Demographics
NPI:1427007764
Name:EAKER, ERVIN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:Y
Last Name:EAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 HILLTOP RD
Mailing Address - Street 2:SUITE170
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3532
Mailing Address - Country:US
Mailing Address - Phone:913-248-8008
Mailing Address - Fax:913-248-8668
Practice Address - Street 1:7230 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9901
Practice Address - Country:US
Practice Address - Phone:913-631-2600
Practice Address - Fax:913-962-2422
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26513207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208648014Medicaid
KS2085556603Medicaid
KSQ449639Medicare ID - Type Unspecified
MO208648014Medicaid