Provider Demographics
NPI:1396840500
Name:EVANS, KIMBERLEY DORENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:DORENE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3469
Mailing Address - Country:US
Mailing Address - Phone:727-939-6196
Mailing Address - Fax:727-350-9396
Practice Address - Street 1:1227 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3469
Practice Address - Country:US
Practice Address - Phone:727-939-6196
Practice Address - Fax:727-350-9396
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0085477207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00932367OtherMEDICARE RAILROAD PROVIDER NUMBER
FL265776700Medicaid
FLH74380Medicare UPIN
FLP00932367OtherMEDICARE RAILROAD PROVIDER NUMBER