Provider Demographics
NPI:1437147899
Name:EAVES, JOHN CRAIG (RPSGT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CRAIG
Last Name:EAVES
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6500 JEFFERSON ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3489
Mailing Address - Country:US
Mailing Address - Phone:505-843-8758
Mailing Address - Fax:505-843-8759
Practice Address - Street 1:3810 MASTHEAD ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4479
Practice Address - Country:US
Practice Address - Phone:505-843-8758
Practice Address - Fax:505-843-8759
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM92-2782084N0400X
NM2581225500000X, 246Z00000X
227800000X, 227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95877321Medicaid
NM81323395Medicaid
NM$$$$$$$$$Medicare PIN