1992781843 NPI number — DR. FLOYD R EVERHART JR. M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992781843 NPI number — DR. FLOYD R EVERHART JR. M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

EVERHART

Provider First Name:

FLOYD

Provider Middle Name:

R

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

JR.

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1992781843

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/15/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

10700 E GEDDES AVE

Provider Second Line Business Mailing Address:

NO 200

Provider Business Mailing Address City Name:

ENGLEWOOD

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

80112-3800

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

501 E HAMPDEN AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ENGLEWOOD

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80113-2702

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

303-761-9190

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

12/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  17201 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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• Identifier: 300090119 . This is a "RR MCRE RIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
• Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 300089926 . This is a "RR MCRE MIC" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
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• Identifier: 200418250A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 300089996 . This is a "RR MCRE DIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".