DR. BRODERICK EATON (NPI# 1992115646) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992115646 |
| Entity Type | Individual |
| Full Name | DR. BRODERICK EATON |
| Credential | DO |
| Practice Address |
601 Julia Ave E Wynne AR 72396-3506 |
| Mailing Address |
Po Box 497 Augusta AR 72006-0497 |
| Practice Telephone | 8702380377 |
| Mailing Telephone | (870) 347-3475 |
| Enumeration Date | 2014-05-03 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | E-9395 | AR | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 214324003 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 223 E Jackson Ave, Jonesboro, AR 724013119 | 8709720063 |
| Street Address |
601 JULIA AVE E |
| City | WYNNE |
| State | AR |
| Zip Code | 72396-3506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487615183 | Arcare | Clinic/Center | 601 Julia Ave E, Wynne, AR 72396-3506 | 2006-03-31 |
| 1972978591 | Ashley Bagwell | Nurse Practitioner | 601 Julia Ave E, Wynne, AR 72396-3506 | 2015-12-08 |
| 1437526944 | Britni Cartillar | Nurse Practitioner | 601 Julia Ave E, Wynne, AR 72396-3506 | 2015-09-01 |
| 1235147513 | Denise Purnell | Nurse Practitioner | 601 Julia Ave E, Wynne, AR 72396-3506 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962918813 | David Makool | Occupational Therapy Assistant | 2000 Gogbill Road, Wynne, AR 72396 | 2017-12-14 |
| 1912425554 | Barbara Ann Burgess | Case Manager/Care Coordinator | 661 Addison, Wynne, AR 72396 | 2017-09-05 |
| 1518481308 | Tyler Leigh Shumard | Physical Therapy Assistant | 128 County Road 145, Wynne, AR 72396 | 2017-08-02 |
| 1588957476 | Northeast Arkansas Community Mental Health Center | Counselor | 661 Addison Dr., Wynne, AR 72396 | 2011-05-25 |
| 1417106493 | Katherine Danielle Calhoun | Dietitian, Registered | 1013 Bridges Ave East, Wynne, AR 72396 | 2008-09-15 |
| 1053531319 | George Scott Puryear, Dds, Pa | Dentist | 715 East Eldrdige Avenue, Wynne, AR 72396 | 2007-04-27 |
| 1730245465 | Marilyn J Cullum | Counselor | 1742 Falls Blvd. Suite 5, The Logan Center, Wynne, AR 72396 | 2006-12-28 |
| 1770655185 | Robert Walton Bassham | Dentist | 669 Addison Drive, Wynne, AR 72396 | 2006-11-14 |
| 1073683827 | George Scott Puryear Jr. | Dentist | 715 E. Eldridge Ave, Wynne, AR 72396 | 2006-11-09 |
| 1194809517 | Richard Keeter Toland | Dentist | 2100 North Killough, Wynne, AR 72396 | 2006-10-24 |
| Find all providers in zip 72396 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346355518 | Mark Standridge Bradshaw | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2006-08-20 |
| 1710517677 | Wynne Physicians Clinic LLC | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2020-01-20 |
| 1659735421 | Jeremiah Nugent | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396 | 2016-04-07 |
| 1417136615 | Wynne Medical Clinic | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2007-10-24 |
| 1538383567 | Wynne Medical Clinic | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2007-04-12 |
| 1972658771 | James R Jacobs | Family Medicine | 411 Falls Blvd S, Wynne, AR 72396-3501 | 2007-01-24 |
| 1548376148 | Wynne Medical Clinic Pa | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2006-08-23 |
| 1396850004 | Robert Andrew Hayes Jr. | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2006-08-20 |
| 1952416653 | James Trent Beaton | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2006-08-20 |
| 1619082310 | Willard Gene Burks | Family Medicine | 710 Falls Blvd S, Wynne, AR 72396-3514 | 2006-08-20 |
| Find all providers in WYNNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.