MEDICARE: JASON EVANS, PA

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	213E00000X	Podiatrist	PO 2835	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA746	OTHER	FL	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1871639104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON EVANS, PA

Provider Business Mailing Address
First Line	:	4750 N FEDERAL HWY
Second Line	:	SUITE 202
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4609
Country	:	US
Telephone Number	:	954-776-0200
Fax Number	:	954-776-8475

Provider Business Practice Location Address
First Line	:	4750 N FEDERAL HWY
Second Line	:	SUITE 202
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4609
Country	:	US
Telephone Number	:	954-776-0200
Fax Number	:	954-776-8475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JASON ANTHONY EVANS
Credential	:	D.P.M.
Telephone Number	:	954-776-0200

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/11/2007

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Directions to “JASON EVANS, PA ” Practice Location

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