MEDICARE: ERIK GENTRY VAN EATON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD00043261	WA
2	2086S0102X	Surgical Critical Care Physician	MD00043261	WA
3	2086S0127X	Trauma Surgery Physician	MD00043261	WA

General Provider Information

NPI Number	:	1265543144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK GENTRY VAN EATON MD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	BOX 356410
City	:	SEATTLE
State	:	WA
Zip	:	98195-6410
Country	:	US
Telephone Number	:	206-685-6660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST
Second Line	:	BOX 6410
City	:	SEATTLE
State	:	WA
Zip	:	98195-6410
Country	:	US
Telephone Number	:	206-685-6660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/30/2009

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