Provider Demographics
NPI:1962442996
Name:EATON, GARY M (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:5353 MISSION CENTER RD
Practice Address - Street 2:STE 224
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1304
Practice Address - Country:US
Practice Address - Phone:619-688-5855
Practice Address - Fax:619-291-3310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC374672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A87936Medicare UPIN
CAWC37467BMedicare ID - Type Unspecified