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General NPI Number Information
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NPI Number | 1306402771
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Entity Type | Individual
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Provider Name | EVAN KLEES R EEG T.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1237 E DUST DEVIL DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4287
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Country | US
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Telephone | 157-085-4979
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Fax |
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Provider Business Mailing Address
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Address Line | 1237 E DUST DEVIL DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4287
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Country | US
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Telephone | 570-854-0790
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | 7039
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License Number State | PA
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