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General NPI Number Information
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NPI Number | 1316202476
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Entity Type | Individual
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Provider Name | EVAN SMALL MD PHD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 34515 9TH AVE S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6761
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Country | US
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Telephone | 253-838-9700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EAU CLAIRE
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State | WI
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Zip | 54702-1510
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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 | 56725
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 62573
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License Number State | WI
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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 | 61617542
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License Number State | WA
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