Healthcare Provider Details

I. General information

NPI: 1033111687
Provider Name (Legal Business Name): DAVID A EVANS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 SOUTHERN BLVD SUITE 213
LOXAHATCHEE FL
33470-9206
US

IV. Provider business mailing address

7593 W BOYNTON BEACH BLVD STE 220
BOYNTON BEACH FL
33437-6162
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-4445
  • Fax: 561-790-4237
Mailing address:
  • Phone: 561-649-7000
  • Fax: 883-162-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS11552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: