Provider Demographics
NPI:1487652467
Name:EVANS, JUDITH L (DO)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2350 SUNSET POINT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1443
Mailing Address - Country:US
Mailing Address - Phone:727-797-3155
Mailing Address - Fax:727-797-4301
Practice Address - Street 1:2350 SUNSET POINT RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-797-3155
Practice Address - Fax:727-797-4301
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2015-01-10
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Provider Licenses
StateLicense IDTaxonomies
FLOS4543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054114100Medicaid
FLE87162Medicare UPIN
FL054114100Medicaid