Provider Demographics
NPI:1255399333
Name:EATON, ALICE AUDREY (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:AUDREY
Last Name:EATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8079 SW SACAJAWEA WAY
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6428
Mailing Address - Country:US
Mailing Address - Phone:503-784-2490
Mailing Address - Fax:
Practice Address - Street 1:3434 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5175
Practice Address - Country:US
Practice Address - Phone:360-413-8364
Practice Address - Fax:360-413-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00030157208000000X, 2080P0204X
ORMD16709208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR036181Medicaid
93112982997006A008OtherTRI WEST
ORF15106OtherPROVIDENCE HEALTH PLAN
OR021993008OtherBLUE CROSS