Provider Demographics
NPI:1639281769
Name:GAYDEN, EVELYN W (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:W
Last Name:GAYDEN
Suffix:
Gender:F
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:PO BOX 1000 DEPT 34
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148
Mailing Address - Country:US
Mailing Address - Phone:901-383-8860
Mailing Address - Fax:901-383-8985
Practice Address - Street 1:50 HUMPHREYS CTR
Practice Address - Street 2:SUITE 23
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2368
Practice Address - Country:US
Practice Address - Phone:901-383-8860
Practice Address - Fax:901-383-8985
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN146582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300138306OtherRAILROAD MEDICARE
MS07428308Medicaid
AR136515001Medicaid
TN3035937Medicaid
AR97877OtherBCBS
TN4053294OtherBCBS
TN3035931Medicare ID - Type Unspecified
AR136515001Medicaid