Healthcare Provider Details

I. General information

NPI: 1679815740
Provider Name (Legal Business Name): BRENT JAMES EATON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

5301 FARAON ST STE 120
SAINT JOSEPH MO
64506-3512
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6350
  • Fax: 816-271-6753
Mailing address:
  • Phone: 816-271-6350
  • Fax: 816-271-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2021019890
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15455
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR9484
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: