Provider Demographics
NPI:1740218064
Name:BEVAN, ALISON J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:J
Last Name:BEVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:916-646-8300
Mailing Address - Fax:916-920-4434
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-672-1351
Practice Address - Fax:530-672-1385
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA661872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661870Medicaid
CAAW762SMedicare PIN
CA00A661870Medicaid