Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 16862 | MS |
N | 207RC0000X | Internist - Cardiovascular Disease | 33865 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | E-2914 | AR |
N | 207RI0011X | Interventional Cardiology | 16862 | MS |
N | 207RI0011X | Interventional Cardiology | 33865 | TN |
Y | 207RI0011X | Interventional Cardiology | 54808 | AZ |
N | 207RI0011X | Interventional Cardiology | MD0000033865 | TN |
N | 207RI0011X | Interventional Cardiology | MD00033175 | WA |
N | 207RI0011X | Interventional Cardiology | MTL-2017-085 | GU |
NPI | 1083799985 |
---|---|
Provider Name | Edward Evans |
First Address | Phoenix, AZ 85006-2707 |
Second Address | Phoenix, AZ 85006-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06552351 | (05) | MS |
103I060822 | MEDICARE PIN (01) | TN |
H26680 | (02) | TN |