MEDICARE: EDWARD BARTON EVANS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G43785	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437293446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD BARTON EVANS M.D.

Provider Business Mailing Address
First Line	:	161 THUNDER DR
Second Line	:	SUITE 104
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-941-6664
Fax Number	:	760-941-3257

Provider Business Practice Location Address
First Line	:	161 THUNDER DR
Second Line	:	SUITE 104
City	:	VISTA
State	:	CA
Zip	:	92083-6016
Country	:	US
Telephone Number	:	760-941-6664
Fax Number	:	760-941-3257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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