Individual
DR. BRODERICK EATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 JULIA AVE E, WYNNE, AR 72396-3506
(870) 238-0377
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-3475
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-9395
AR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214324003
—
AR
Enumeration date
05/03/2014
Last updated
07/21/2022
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