Healthcare Provider Details

I. General information

NPI: 1548294481
Provider Name (Legal Business Name): ELIZABETH ANNE EADS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CHEROKEE TRL
ORMOND BEACH FL
32174-8523
US

IV. Provider business mailing address

5 CARRINGTON LN
ORMOND BEACH FL
32174-3897
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-0255
  • Fax: 386-676-2555
Mailing address:
  • Phone: 386-615-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0007549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: