Healthcare Provider Details

I. General information

NPI: 1629369467
Provider Name (Legal Business Name): DANIEL ADRIAN EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM DEPARTMENT OF PSYCHIATRY 1 UNIVERSITY OF NEW MEXICO MSC09 5030
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

UNM DEPARTMENT OF PSYCHIATRY 1 UNIVERSITY OF NEW MEXICO MSC09 5030
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2223
  • Fax:
Mailing address:
  • Phone: 505-272-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD2014-0815
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: