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General NPI Number Information
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NPI Number | 1568928588
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Entity Type | Organization
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Legal Business Name | J ROBERT EVANS MD PC
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 02/14/2019
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Provider Practice Location Address
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Address Line | 355 E 21ST ST STE H
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4851
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Country | US
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Telephone | 909-886-2609
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Fax |
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Provider Business Mailing Address
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Address Line | 212 SUMMIT AVE
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City | REDLANDS
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State | CA
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Zip | 92373-6852
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Country | US
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Telephone | 909-793-5511
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Fax | 909-792-5531
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Authorized Official
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Title or Position | OWNER
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Name | J ROBERT EVANS
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Credential | MD
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Telephone | 909-793-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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