Provider Demographics
NPI:1609841618
Name:EVANS, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:507 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2618
Practice Address - Country:US
Practice Address - Phone:239-772-0500
Practice Address - Fax:239-772-3076
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038033208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065714000Medicaid
FL4091480OtherAETNA PROVIDER NUMBER
FL739090OtherFIRST HLTH/CCN PROVIDER #
FL96131OtherOP. ENGIN. PROVIDER #
FL1793617-007OtherCIGNA PROVIDER NUMBER
FL79594OtherBCBS PROVIDER NUMBER
FL166642OtherUSA MNGD. CR. PROVIDER #
FL15752OtherWELLCARE
FL255642OtherAVMED PROVIDER NUMBER
FLME0038033OtherMETCARE PROVIDER NUMBER
FL255642OtherAVMED PROVIDER NUMBER
FLC46259Medicare UPIN