Provider Demographics
NPI:1114905635
Name:EVANS, R. BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:BLAIR
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:BLAIR
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-215-2004
Mailing Address - Fax:206-215-2055
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-215-2020
Practice Address - Fax:206-215-2022
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018428207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8163107Medicaid
180016726OtherRAILROAD MEDICARE
E781OtherREGENCE HEALTHCARE
WA0036110OtherLABOR & INDUSTRIES
WA0036110OtherLABOR & INDUSTRIES
A06702Medicare UPIN