Provider Demographics
NPI:1346388097
Name:EVAN M VAPNEK MD & JAMES L ROBERTS MD, A MEDICAL GROUP
Entity Type:Organization
Organization Name:EVAN M VAPNEK MD & JAMES L ROBERTS MD, A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VAPNEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-299-0670
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-429-7929
Practice Address - Street 1:4033 3RD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2117
Practice Address - Country:US
Practice Address - Phone:619-299-0670
Practice Address - Fax:858-429-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO43510Medicaid
CAW19417Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER