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General NPI Number Information
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NPI Number | 1073167359
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Entity Type | Organization
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Legal Business Name | EVANSTON REGIONAL PHYSICIANS LLC
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 190 ARROWHEAD DR
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City | EVANSTON
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State | WY
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Zip | 82930-9266
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Country | US
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Telephone | 307-789-3636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 734597
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City | CHICAGO
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State | IL
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Zip | 60673-4597
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT H. PARKER JR.
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Credential |
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Telephone | 801-463-7415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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