MEDICARE: EVENSEN & TRIPPI PLLC

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	207RB0002X	Obesity Medicine (Internal Medicine) Physician	1170	NV

General Provider Information

NPI Number	:	1962769950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVENSEN & TRIPPI PLLC

Provider Business Mailing Address
First Line	:	607 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3912
Country	:	US
Telephone Number	:	702-822-7400
Fax Number	:	702-822-7425

Provider Business Practice Location Address
First Line	:	607 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3912
Country	:	US
Telephone Number	:	702-822-7400
Fax Number	:	702-822-7425

Authorized Official
Title or Position	:	MEMBER
Name	:	ERIK EVENSEN
Credential	:	DO
Telephone Number	:	702-822-7400

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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