Healthcare Provider Details

I. General information

NPI: 1801329586
Provider Name (Legal Business Name): EVAN LAYTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 BIG BEND RD STE 103
RIVERVIEW FL
33578-7421
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8740
  • Fax: 813-605-8740
Mailing address:
  • Phone: 727-315-6974
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS16912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: