Healthcare Provider Details

I. General information

NPI: 1841432648
Provider Name (Legal Business Name): EVONNA PRICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140B S FEDERAL HWY
DANIA FL
33004-3623
US

IV. Provider business mailing address

975 CORKWOOD ST
HOLLYWOOD FL
33019-4878
US

V. Phone/Fax

Practice location:
  • Phone: 954-922-7606
  • Fax: 954-985-0492
Mailing address:
  • Phone: 954-922-7606
  • Fax: 954-985-0492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME68543
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME68543
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: