Healthcare Provider Details

I. General information

NPI: 1942596523
Provider Name (Legal Business Name): JOHN DAVID EATMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 KESSLER ST STE 205
MERRIAM KS
66204-2553
US

IV. Provider business mailing address

7450 KESSLER ST STE 205
MERRIAM KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9810
  • Fax: 913-632-9828
Mailing address:
  • Phone: 913-632-9810
  • Fax: 913-632-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2016025183
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberBP10040654
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-39266
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: