Provider Demographics
NPI:1184036774
Name:WERK, EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:WERK
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 1:1320 N 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2710
Mailing Address - Country:US
Mailing Address - Phone:602-839-7285
Mailing Address - Fax:
Practice Address - Street 1:1320 N 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2710
Practice Address - Country:US
Practice Address - Phone:602-839-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74329207Q00000X
AZ55318207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine