Provider Demographics
NPI:1104592294
Name:EAGLETON, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:EAGLETON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 E 46TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-5148
Mailing Address - Country:US
Mailing Address - Phone:918-691-0055
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:832-325-7125
Practice Address - Fax:713-512-2200
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program