Healthcare Provider Details

I. General information

NPI: 1972124386
Provider Name (Legal Business Name): JARED ANDREW EAVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W COLORADO BLVD
DALLAS TX
75208-2382
US

IV. Provider business mailing address

122 W COLORADO BLVD
DALLAS TX
75208-2382
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-6700
  • Fax: 214-947-6701
Mailing address:
  • Phone: 214-947-6700
  • Fax: 214-947-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberV1073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: