MEDICARE: BRENT MONROE EVANS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	665	NC

General Provider Information

NPI Number	:	1851701163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT MONROE EVANS DPM

Provider Business Mailing Address
First Line	:	2001 N CHURCH ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5633
Country	:	US
Telephone Number	:	336-375-6990
Fax Number	:	336-375-0361

Provider Business Practice Location Address
First Line	:	2001 N CHURCH ST STE 101
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5633
Country	:	US
Telephone Number	:	336-375-6990
Fax Number	:

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	02/28/2024

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