| Doctor Name: | MARY DAN EADES |
| NPI Number: | 1164790994 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 36065 |
| Business Practice Address: | 6525 Gunpark Dr # 150-504 Boulder, CO - 803013346 |
| Business Phone Number: | 7203406306 |
| Business Fax Number: | 8055653142 |
| Mailing Address: | 6525 Gunpark Dr # 150-504, BOULDER |
| State: | CO |
| Postal Code: | 803013346 |
| Phone Number: | 7203406306 |
| Fax Number: | 8055653142 |
| NPI Enumeration Date: | 12/07/2011 |
| NPI Last Update Date: | 12/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 36065 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |