Provider Demographics
NPI:1144301300
Name:EATON, MARK ADALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ADALBERT
Last Name:EATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4316
Mailing Address - Country:US
Mailing Address - Phone:541-282-6559
Mailing Address - Fax:541-282-6710
Practice Address - Street 1:520 MEDICAL CENTER DR
Practice Address - Street 2:STE 300
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4316
Practice Address - Country:US
Practice Address - Phone:541-282-6559
Practice Address - Fax:541-282-6710
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22875208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4898012OtherBLUE CROSS
OR109130OtherMEDICARE
OR287578Medicaid
OR287578Medicaid