Provider Demographics
NPI:1790760296
Name:EVANS, BOYD D JR (MD)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:D
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:12276 SAN JOSE BLVD STE 617
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8672
Practice Address - Country:US
Practice Address - Phone:904-262-9075
Practice Address - Fax:904-262-9076
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2024-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME89795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL298353OtherAVMED
FL4881981OtherCIGNA
FL7213790OtherAETNA
FL29493OtherBCBS
FL301810OtherHEALTHEASE
FL7213790OtherAETNA
FL29493OtherBCBS
FLI42842Medicare UPIN