=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184603441
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT STEPHEN EVANS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 04/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55585 29 PALMS HWY
-----------------------------------------------------
City | YUCCA VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92284-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-228-3366
-----------------------------------------------------
Fax | 760-228-3369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55585 29 PALMS HWY
-----------------------------------------------------
City | YUCCA VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92284-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-228-3366
-----------------------------------------------------
Fax | 760-228-3369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G36975
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------