Healthcare Provider Details

I. General information

NPI: 1407793078
Provider Name (Legal Business Name): EVANS ALTENOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-2 KM 173
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PR-2 KM 173
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1860
  • Fax: 787-264-7908
Mailing address:
  • Phone: 787-892-1860
  • Fax: 787-264-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number002551
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: