Healthcare Provider Details

I. General information

NPI: 1649239757
Provider Name (Legal Business Name): JOHN L ETEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MAIN ST ORLEANS MEDICAL CENTER, P.C.
ORLEANS MA
02653-3428
US

IV. Provider business mailing address

204 MAIN ST ORLEANS MEDICAL CENTER, P.C.
ORLEANS MA
02653-3428
US

V. Phone/Fax

Practice location:
  • Phone: 508-255-8825
  • Fax:
Mailing address:
  • Phone: 508-255-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: