Provider Demographics
NPI:1073771036
Name:KRASNER, EVAN SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:SAMUEL
Last Name:KRASNER
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 1:506 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3619
Mailing Address - Country:US
Mailing Address - Phone:510-221-7756
Mailing Address - Fax:
Practice Address - Street 1:506 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3619
Practice Address - Country:US
Practice Address - Phone:510-221-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine