Healthcare Provider Details

I. General information

NPI: 1083799985
Provider Name (Legal Business Name): EDWARD EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWARD MORGAN EVANS MD

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

IV. Provider business mailing address

1331 N 7TH ST STE 375
PHOENIX AZ
85006-2707
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-0070
  • Fax: 602-307-0080
Mailing address:
  • Phone: 602-307-0070
  • Fax: 602-307-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number16862
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33865
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-2914
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD00033175
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD0000033865
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number33865
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number16862
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMTL-2017-085
License Number StateGU
# 9
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number54808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: