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General NPI Number Information
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NPI Number | 1790050409
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 4643 N 12TH ST STE 101
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City | PHOENIX
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State | AZ
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Zip | 85014-4083
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Country | US
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Telephone | 602-812-3789
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Fax |
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Provider Business Mailing Address
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Address Line | 4643 N 12TH ST STE 101
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City | PHOENIX
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State | AZ
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Zip | 85014-4083
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Country | US
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Telephone | 602-812-3789
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES BENJAMIN EVANS II
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Credential | MD
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Telephone | 602-292-0552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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