MEDICARE: DR. ROBERT W. EATON, PC

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	305R00000X	Preferred Provider Organization

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	:	1265477541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROBERT W. EATON, PC

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	:	PHYSICIAN
Name	:	DR. ROBERT W EATON
Credential	:	DO
Telephone Number	:	205-339-2499

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	12/15/2009

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