1942206701 NPI number — THEODORE ALFRED EVANS MD

Table of content: THEODORE ALFRED EVANS MD (NPI 1942206701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942206701 NPI number — THEODORE ALFRED EVANS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
THEODORE
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1942206701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 NE 30TH TER
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HOMESTEAD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33033-7613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-247-1701
Provider Business Mailing Address Fax Number:
305-247-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 NE 30TH TER
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HOMESTEAD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-247-1701
Provider Business Practice Location Address Fax Number:
305-247-1799
Provider Enumeration Date:
06/24/2005

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: 207X00000X , with the licence number:  ME47564 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942206701 . This is a "MD MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 592417574001 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12255 . This is a "WELL CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13451 . This is a "ALL FLORIDA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250454500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54115 . This is a "JMH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273479 . This is a "ONE HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200010270 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9319 . This is a "FOUNDATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003510 . This is a "PHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08743 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7574 . This is a "AV MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011890900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com