Healthcare Provider Details

I. General information

NPI: 1992016083
Provider Name (Legal Business Name): JOSHUA LEE EATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
ANCHORAGE AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
ANCHORAGE AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-552-2992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number26607
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26607
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: