Provider Demographics
NPI:1982715397
Name:EATON, RICKY R (PA-C)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:R
Last Name:EATON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2277
Mailing Address - Country:US
Mailing Address - Phone:303-330-0410
Mailing Address - Fax:303-330-0732
Practice Address - Street 1:24300 E SMOKY HILL RD UNIT 120
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1387
Practice Address - Country:US
Practice Address - Phone:303-330-0410
Practice Address - Fax:303-330-0732
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE645363AM0700X
CO2701363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
37895OtherBCBS
8834OtherMIDLANDS CHOICE
CO06550037Medicaid
8834OtherMIDLANDS CHOICE
970017001Medicare PIN
37895OtherBCBS
281554Medicare PIN
COCO306085Medicare PIN