MEDICARE: DR. ROBERT W EATON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0441	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51515058	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073513479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W EATON DO

Provider Business Mailing Address
First Line	:	5004 HIGHWAY 69 N
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-2039
Country	:	US
Telephone Number	:	205-339-2499
Fax Number	:	205-339-6422

Provider Business Practice Location Address
First Line	:	5004 HIGHWAY 69 N
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-2039
Country	:	US
Telephone Number	:	205-339-2499
Fax Number	:	205-339-6422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/06/2012

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Directions to “ DR. ROBERT W EATON DO” Practice Location

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