Healthcare Provider Details

I. General information

NPI: 1982167276
Provider Name (Legal Business Name): EVAN CHASE WASSERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST STE 705
SARASOTA FL
34239-2913
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-5864
  • Fax: 941-365-4276
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS19928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: