MEDICARE: DR. LESLIE LOGAN EVANS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	25937	AL

General Provider Information

NPI Number	:	1487872271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE LOGAN EVANS MD

Provider Business Mailing Address
First Line	:	104 KEPLER PL
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-3465
Country	:	US
Telephone Number	:	251-622-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 S INGLESIDE ST STE 6
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-1804
Country	:	US
Telephone Number	:	251-929-1222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	06/27/2014

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Directions to “ DR. LESLIE LOGAN EVANS MD” Practice Location

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