Provider Demographics
NPI:1104858059
Name:EVANS, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:EVANS
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:PO BOX 5157
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92412-5157
Mailing Address - Country:US
Mailing Address - Phone:909-580-6240
Mailing Address - Fax:909-580-6308
Practice Address - Street 1:ARROWHEAD REGIONAL MEDICAL CENTER
Practice Address - Street 2:400 N. PEPPER AVENUE
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-9999
Practice Address - Country:US
Practice Address - Phone:909-580-6240
Practice Address - Fax:909-580-6308
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G694160Medicaid
CA00G694161Medicare ID - Type Unspecified
CA00G694160Medicaid