Healthcare Provider Details

I. General information

NPI: 1427007764
Provider Name (Legal Business Name): ERVIN Y EAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 RENNER RD
SHAWNEE KS
66217-9901
US

IV. Provider business mailing address

6850 HILLTOP RD SUITE170
SHAWNEE KS
66226-3532
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-2600
  • Fax: 913-962-2422
Mailing address:
  • Phone: 913-248-8008
  • Fax: 913-248-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number04-26513
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: