Provider Demographics
NPI:1447203070
Name:EATON, DENNIS RANDALL (PA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:RANDALL
Last Name:EATON
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 1:801 NORTH MURLEN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-764-0036
Mailing Address - Fax:913-780-2099
Practice Address - Street 1:801 NORTH MURLEN
Practice Address - Street 2:SUITE 201
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-764-0036
Practice Address - Fax:913-780-2099
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0338689DMedicare ID - Type Unspecified
E68831Medicare UPIN