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General NPI Number Information
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NPI Number | 1588069546
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Entity Type | Organization
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Legal Business Name | DAVID EVANS DO INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 11/01/2014
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Last Update Date | 11/01/2014
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD SUITE 121
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9206
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Country | US
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Telephone | 561-790-4445
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Fax | 561-790-4237
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Provider Business Mailing Address
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Address Line | 15642 CYPRESS PARK DR
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City | WELLINGTON
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State | FL
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Zip | 33414-6356
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Country | US
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Telephone | 609-440-7386
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Fax | 561-225-1803
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DAVID EVANS
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Credential | D.O.
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Telephone | 609-440-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS-11552
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License Number State | FL
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