Provider Demographics
NPI:1639556996
Name:SAM EVANS, MD
Entity Type:Organization
Organization Name:SAM EVANS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-3773
Mailing Address - Street 1:550 S BERETANIA STREET
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2496
Mailing Address - Country:US
Mailing Address - Phone:808-536-3773
Mailing Address - Fax:
Practice Address - Street 1:550 S. BERETANIA STREET
Practice Address - Street 2:SUITE 501
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96823-2496
Practice Address - Country:US
Practice Address - Phone:808-536-3773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-10768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty