Individual
MARY KATHRYN EAGLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8288 S BROADWAY AVE, TYLER, TX 75703-5262
(903) 606-7060
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
BP1-0039531
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376763401
—
TX
01
—
75-2616977-118
TRICARE
TX
01
—
8HE842
BCBS
TX
01
—
P01912556
MEDICARE RAIL ROAD
TX
Enumeration date
05/27/2011
Last updated
03/17/2018
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