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General NPI Number Information
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NPI Number | 1235507724
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Entity Type | Individual
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Provider Name | JUSTIN EVANS
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Gender | Male
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 476 NEWLAND ST
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City | LAKEWOOD
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State | CO
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Zip | 80226
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Country | US
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Telephone | 717-341-0388
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Fax |
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Provider Business Mailing Address
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Address Line | 476 NEWLAND ST
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City | LAKEWOOD
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State | CO
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Zip | 80226-1765
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A16081
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License Number State | CA
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