Provider Demographics
NPI:1508841016
Name:AYERDI, EVALT (MD)
Entity Type:Individual
Prefix:DR
First Name:EVALT
Middle Name:
Last Name:AYERDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:WILLIAM BEAUMONT ARMY MEDICAL CENTER
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930
Mailing Address - Country:US
Mailing Address - Phone:269-381-3963
Mailing Address - Fax:269-381-2809
Practice Address - Street 1:5005 N. PIEDRAS
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930
Practice Address - Country:US
Practice Address - Phone:915-742-1840
Practice Address - Fax:269-381-2809
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041454207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3190141Medicaid
MI3190141Medicaid