MEDICARE: DWIGHT CHARLES 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	207R00000X	Internal Medicine Physician	G56590	CA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G56590	CA

General Provider Information

NPI Number	:	1760420509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWIGHT CHARLES EVANS M.D.

Provider Business Mailing Address
First Line	:	3063 CANYON VISTA DR
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-9791
Country	:	US
Telephone Number	:	909-824-6411
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA LOMA LINDA HEALTHCARE SYSTEM
Second Line	:	11201 BENTON STREET
City	:	LOMA LINDA
State	:	CA
Zip	:	92357-0001
Country	:	US
Telephone Number	:	909-583-6007
Fax Number	:	909-777-3236

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/11/2025

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