MEDICARE: MR. ROBERT D EVANS BSBCHIS

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	237700000X	Hearing Instrument Specialist	AS1373	FL

General Provider Information

NPI Number	:	1801058227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT D EVANS BSBCHIS

Provider Business Mailing Address
First Line	:	9156 SEMINOLE BLVD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-3148
Country	:	US
Telephone Number	:	727-393-3775
Fax Number	:	727-393-3113

Provider Business Practice Location Address
First Line	:	9156 SEMINOLE BLVD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33772-3148
Country	:	US
Telephone Number	:	727-393-3775
Fax Number	:	727-393-3113

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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