Provider Demographics
NPI:1467505479
Name:EVANS, PETER ABRAHAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ABRAHAM
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-6803
Mailing Address - Country:US
Mailing Address - Phone:570-648-8531
Mailing Address - Fax:
Practice Address - Street 1:23 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6803
Practice Address - Country:US
Practice Address - Phone:570-648-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003891L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014833690002Medicaid
PA480017859OtherRAIL ROAD MEDICARE
PAEV021606Medicare ID - Type Unspecified
PAU49860Medicare UPIN