Provider Demographics
NPI:1225189798
Name:EVANS, JOAN D (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:D
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2849
Mailing Address - Country:US
Mailing Address - Phone:910-576-2212
Mailing Address - Fax:910-576-2212
Practice Address - Street 1:433 WOOD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2849
Practice Address - Country:US
Practice Address - Phone:910-576-2212
Practice Address - Fax:910-576-2212
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264213E00000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890805GMedicaid
NC0805GOtherBLUE CROSS BLUE SHIELD
NC890805GMedicaid
NC0805GOtherBLUE CROSS BLUE SHIELD