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General NPI Number Information
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NPI Number | 1861619272
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Entity Type | Individual
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Provider Name | JEFFERY B EVANS
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 1835 FRANKLIN ST
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City | DENVER
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State | CO
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Zip | 80218-1126
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Country | US
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Telephone | 303-743-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 55TH ST
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City | BOULDER
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State | CO
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Zip | 80303-2930
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Country | US
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Telephone | 303-278-7581
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1324
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License Number State | CO
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