Provider Demographics
NPI:1649220591
Name:EATON, LELAND W (MD)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:W
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:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25035207RC0000X
AL13274207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051598080OtherBLUE CROSS
AL160070286OtherRAILROAD MEDICARE
AL051102151OtherBLUE CROSS
AL051514391OtherBLUE CROSS
GA000344638GMedicaid
AL115616Medicaid
AL009912155Medicaid
AL051513542OtherBLUE CROSS
AL051534254Medicaid
MS08473001Medicaid
AL009913435Medicaid
AL009937024Medicaid
AL051514389OtherBLUE CROSS
AL051552984Medicaid
AL051598085OtherBLUE CROSS
AL051514391OtherBLUE CROSS
AL009937024Medicaid