Provider Demographics
NPI:1043206972
Name:EVANOFF, GEORGE V (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:V
Last Name:EVANOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 HEMLOCK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2689
Mailing Address - Country:US
Mailing Address - Phone:360-377-7634
Mailing Address - Fax:360-479-6157
Practice Address - Street 1:2771 HEMLOCK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2689
Practice Address - Country:US
Practice Address - Phone:360-377-7634
Practice Address - Fax:360-479-6157
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031897207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1088566Medicaid
1043206972OtherNPI
WA1088566Medicaid
1043206972OtherNPI