Healthcare Provider Details

I. General information

NPI: 1376533869
Provider Name (Legal Business Name): EVAN R. MEEKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E. HIGHWAY 20 PEDIATRIC DEPARTMENT
NICEVILLE FL
32578
US

IV. Provider business mailing address

2001 E. HIGHWAY 20 PEDIATRIC DEPARTMENT
NICEVILLE FL
32578
US

V. Phone/Fax

Practice location:
  • Phone: 850-897-4400
  • Fax: 850-897-0623
Mailing address:
  • Phone: 850-897-4400
  • Fax: 850-897-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: