Provider Demographics
NPI:1710980743
Name:ALLEN, EVAN C (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701N GREEN VALLEY PKWY 5C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5889
Mailing Address - Country:US
Mailing Address - Phone:702-541-8240
Mailing Address - Fax:702-541-8241
Practice Address - Street 1:1701N GREEN VALLEY PKWY 5C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5889
Practice Address - Country:US
Practice Address - Phone:702-541-8240
Practice Address - Fax:702-541-8241
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV7132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104006Medicare PIN