Healthcare Provider Details

I. General information

NPI: 1588614259
Provider Name (Legal Business Name): EATON I YEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 PICTON WAY SUITE 101
TRINITY FL
34655-1792
US

IV. Provider business mailing address

PO BOX 340287
TAMPA FL
33694-0287
US

V. Phone/Fax

Practice location:
  • Phone: 727-359-2552
  • Fax: 727-372-0402
Mailing address:
  • Phone: 727-359-2552
  • Fax: 727-372-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS9263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: