Provider Demographics
NPI:1598730665
Name:EATON, EDWARD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:EATON
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 1:15013 ANILLO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9422
Mailing Address - Country:US
Mailing Address - Phone:916-270-9747
Mailing Address - Fax:
Practice Address - Street 1:10633 GRISSOM AVE
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4123
Practice Address - Country:US
Practice Address - Phone:916-355-5420
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS157052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry