Individual
JAMES R. EDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1900 S NATIONAL AVE, SUITE 1950, SPRINGFIELD, MO 65804-2265
(417) 820-7250
(417) 820-7255
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2002001246
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263006
TRICARE
—
Enumeration date
11/30/2006
Last updated
07/11/2008
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