Provider Demographics
NPI:1265419550
Name:EATON, KURTIS W (MD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:W
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2050 VILLAGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-1107
Mailing Address - Country:US
Mailing Address - Phone:205-640-1793
Mailing Address - Fax:205-640-1823
Practice Address - Street 1:2050 VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-1107
Practice Address - Country:US
Practice Address - Phone:205-640-1793
Practice Address - Fax:205-640-1823
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALMD22448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11873Medicare UPIN