Healthcare Provider Details

I. General information

NPI: 1326088014
Provider Name (Legal Business Name): JEFFREY LEWIS EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 1400
SEATTLE WA
98104-4308
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6266
  • Fax: 206-386-2844
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD00046254
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: