Provider Demographics
NPI:1245410059
Name:ROBERT T EVANS DPM PLC
Entity Type:Organization
Organization Name:ROBERT T EVANS DPM PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-895-0276
Mailing Address - Street 1:270 W CHANDLER HEIGHTS RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5055
Mailing Address - Country:US
Mailing Address - Phone:480-895-0276
Mailing Address - Fax:480-895-6933
Practice Address - Street 1:270 W CHANDLER HEIGHTS RD
Practice Address - Street 2:SUITE #5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5055
Practice Address - Country:US
Practice Address - Phone:480-895-0276
Practice Address - Fax:480-895-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0605213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108578OtherMEDICARE GROUP PIN
5669880001Medicare NSC
AZ108579Medicare PIN
AZV01037Medicare UPIN