Provider Demographics
NPI:1750952503
Name:EATON, JAVON XAVIER (BS)
Entity type:Individual
Prefix:
First Name:JAVON
Middle Name:XAVIER
Last Name:EATON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9926 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1451
Mailing Address - Country:US
Mailing Address - Phone:954-326-5519
Mailing Address - Fax:
Practice Address - Street 1:1101 TAURUS CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4347
Practice Address - Country:US
Practice Address - Phone:954-326-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program