Provider Demographics
NPI:1548294481
Name:EADS, ELIZABETH ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:EADS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3897
Mailing Address - Country:US
Mailing Address - Phone:386-615-0959
Mailing Address - Fax:
Practice Address - Street 1:39 CHEROKEE TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8523
Practice Address - Country:US
Practice Address - Phone:386-676-0255
Practice Address - Fax:386-676-2555
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255008300Medicaid
FL56760OtherBLUE CROSS & BLUE SHIELD
FL56760OtherBLUE CROSS & BLUE SHIELD
FL255008300Medicaid