Healthcare Provider Details

I. General information

NPI: 1366402513
Provider Name (Legal Business Name): EUGENE EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 RUTH HENTZ AVE
PANAMA CITY FL
32405-2259
US

IV. Provider business mailing address

PO BOX 15188
PANAMA CITY FL
32406-5188
US

V. Phone/Fax

Practice location:
  • Phone: 850-522-4848
  • Fax: 850-784-7706
Mailing address:
  • Phone: 850-522-4848
  • Fax: 850-784-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME59546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: