Healthcare Provider Details

I. General information

NPI: 1265271548
Provider Name (Legal Business Name): JEFFREY EATON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SPRING ST STE 101
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

49 SPRING ST STE 101
SCARBOROUGH ME
04074-8926
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-7926
  • Fax: 207-618-5021
Mailing address:
  • Phone: 207-883-7926
  • Fax: 207-618-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3102
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: