Provider Demographics
NPI:1679815740
Name:EATON, BRENT JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMES
Last Name:EATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5301 FARAON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3512
Mailing Address - Country:US
Mailing Address - Phone:816-271-1066
Mailing Address - Fax:816-271-6786
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-6350
Practice Address - Fax:816-271-6350
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2021019890207L00000X
CA15455207L00000X
TXR9484207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology