Healthcare Provider Details

I. General information

NPI: 1215965405
Provider Name (Legal Business Name): PETER JOHN EVANS MD, PHD, FAAOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SE SALERNO RD STE 110
STUART FL
34997-6572
US

IV. Provider business mailing address

2100 SE SALERNO RD
STUART FL
34997-6503
US

V. Phone/Fax

Practice location:
  • Phone: 772-781-2735
  • Fax: 727-781-2739
Mailing address:
  • Phone: 772-223-5700
  • Fax: 727-223-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35079068E
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number143787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: