Healthcare Provider Details

I. General information

NPI: 1144301300
Provider Name (Legal Business Name): MARK ADALBERT EATON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

IV. Provider business mailing address

520 MEDICAL CENTER DR STE 300
MEDFORD OR
97504-4316
US

V. Phone/Fax

Practice location:
  • Phone: 541-282-6559
  • Fax: 541-282-6710
Mailing address:
  • Phone: 541-282-6559
  • Fax: 541-282-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD22875
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD22875
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: