MEDICARE: WILLIAM NEAL EVANS, MD, LTD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	133V00000X	Registered Dietitian
3	170300000X	Genetic Counselor (M.S.)
4	363LF0000X	Family Nurse Practitioner
5	2080P0202X	Pediatric Cardiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	XGG007170	OTHER		MEDI-CAL

General Provider Information

NPI Number	:	1720110190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM NEAL EVANS, MD, LTD

Provider Business Mailing Address
First Line	:	3131 LA CANADA ST STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2551
Country	:	US
Telephone Number	:	702-732-1290
Fax Number	:	702-732-1385

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0515
Country	:	US
Telephone Number	:	702-732-1290
Fax Number	:	702-732-1385

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LESLIE JOHNSON
Credential	:
Telephone Number	:	702-990-4821

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	05/01/2025

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Directions to “WILLIAM NEAL EVANS, MD, LTD ” Practice Location

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