Provider Demographics
NPI:1588664049
Name:EVES, WILLIAM COLLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COLLIN
Last Name:EVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:STE 307
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-426-3240
Mailing Address - Fax:619-426-5964
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:STE 307
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-426-3240
Practice Address - Fax:619-426-5964
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65653207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65653OtherST LICENSE
CA00A656531Medicaid
CA00A656531Medicaid
H60444Medicare UPIN