1144281353 NPI number — MR. DEAN ERNEST EVANS PA-C

Table of content: MR. DEAN ERNEST EVANS PA-C (NPI 1144281353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144281353 NPI number — MR. DEAN ERNEST EVANS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
DEAN
Provider Middle Name:
ERNEST
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144281353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 N FLAGLER DR
Provider Second Line Business Mailing Address:
#2303
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-842-0156
Provider Business Mailing Address Fax Number:
561-842-0156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11924 FOREST HILL BLVD # 10A-243
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-6256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-693-5143
Provider Business Practice Location Address Fax Number:
561-245-9150
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA9109897 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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