Healthcare Provider Details

I. General information

NPI: 1164748901
Provider Name (Legal Business Name): ALEXANDER EVENS, DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELBON AVE STE 5
TURLOCK CA
95382-2006
US

IV. Provider business mailing address

220 STANDIFORD AVE STE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-656-0183
  • Fax: 209-656-0199
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number20A9461
License Number StateCA

VIII. Authorized Official

Name: ALEXANDER RONALD EVENS
Title or Position: PRESIDENT
Credential: MD
Phone: 209-656-0183