Provider Demographics
NPI:1588614259
Name:YEN, EATON I (DO)
Entity Type:Individual
Prefix:DR
First Name:EATON
Middle Name:I
Last Name:YEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340287
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33694-0287
Mailing Address - Country:US
Mailing Address - Phone:727-359-2552
Mailing Address - Fax:727-372-0402
Practice Address - Street 1:8140 PICTON WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1792
Practice Address - Country:US
Practice Address - Phone:727-359-2552
Practice Address - Fax:727-372-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS92632081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI19014Medicare UPIN
FL48321ZMedicare PIN
FLBS680ZMedicare PIN