Provider Demographics
NPI:1285776054
Name:EATON, BERNADETTE VEZA (MD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:VEZA
Last Name:EATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNADETTE
Other - Middle Name:AGUILAR
Other - Last Name:VEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2469
Mailing Address - Country:US
Mailing Address - Phone:502-852-8500
Mailing Address - Fax:
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-6000
Practice Address - Fax:502-852-8556
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY407252080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100008630Medicaid
IN200886380Medicaid
KY7100008630Medicaid