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General NPI Number Information
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NPI Number | 1760892483
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Entity Type | Organization
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Legal Business Name | GREGORY T EVANGELISTA MD LLC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 09/02/2019
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Provider Practice Location Address
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Address Line | 3271 N CIVIC CENTER PLZ STE 110
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6990
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Country | US
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Telephone | 480-656-0291
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Fax | 480-656-0127
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Provider Business Mailing Address
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Address Line | PO BOX 5495
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City | SCOTTSDALE
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State | AZ
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Zip | 85261-5495
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Country | US
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Telephone | 480-656-0291
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Fax | 480-656-0127
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | GREGORY T EVANGELISTA
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Credential | M.D.
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Telephone | 480-254-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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