Provider Demographics
NPI:1083799985
Name:EVANS, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:MORGAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1331 N 7TH ST STE 375
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2707
Mailing Address - Country:US
Mailing Address - Phone:602-307-0070
Mailing Address - Fax:602-307-0080
Practice Address - Street 1:1331 N 7TH ST STE 375
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2707
Practice Address - Country:US
Practice Address - Phone:602-307-0070
Practice Address - Fax:602-307-0080
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16862207RC0000X, 207RI0011X
TN33865207RC0000X, 207RI0011X
ARE-2914207RC0000X
WAMD00033175207RI0011X
TNMD0000033865207RI0011X
GUMTL-2017-085207RI0011X
AZ54808207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06552351Medicaid
TN103I060822OtherMEDICARE PIN
TN38584361Medicare PIN
MS06552351Medicaid
MS30206I0823Medicare PIN