Healthcare Provider Details

I. General information

NPI: 1780716407
Provider Name (Legal Business Name): JAMES H EVANS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W BIJOU ST SUITE C
COLORADO SPRINGS CO
80905-1309
US

IV. Provider business mailing address

402 W BIJOU ST SUITE C
COLORADO SPRINGS CO
80905-1309
US

V. Phone/Fax

Practice location:
  • Phone: 719-520-1102
  • Fax: 719-302-6686
Mailing address:
  • Phone: 719-520-1102
  • Fax: 719-302-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number568
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: