Provider Demographics
NPI:1124079256
Name:EATON, MARK THOMAS (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:EATON
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1738 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-484-4191
Mailing Address - Fax:910-484-5546
Practice Address - Street 1:1738 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-484-4191
Practice Address - Fax:910-484-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC423213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126JKMedicaid
NC126JKOtherBCBS
NC89126JKMedicaid
NCU79909Medicare UPIN