Healthcare Provider Details

I. General information

NPI: 1487353090
Provider Name (Legal Business Name): EVAN CHRISTOPHER BILES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 07/30/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC-B ATTN: CREDENTIALS OFFICE CMR BLDG 700, ROOM 59
APO AE
09112
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2368
  • Fax:
Mailing address:
  • Phone: 253-968-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number92981
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: