Provider Demographics
NPI: | 1821200452 |
---|---|
Name: | EVANS, RACHEL H (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | RACHEL |
Middle Name: | H |
Last Name: | EVANS |
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: | 16248 E POWDERHORN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FOUNTAIN HILLS |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85268-6527 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-816-5932 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 16248 E POWDERHORN DR |
Practice Address - Street 2: | |
Practice Address - City: | FOUNTAIN HILLS |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85268-6527 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-816-5932 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-05-04 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 13619 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 1115101 | Other | CIGNA PROVIDER NUMBER |
AZ | 13619 | Other | STATE LICENSE NUMBER |
AZ | AE2599617 | Other | DEA NUMBER |
AZ | AE2599617 | Other | DEA NUMBER |
AZ | Z22342 | Medicare ID - Type Unspecified | MEDICARE PROVIDER NUMBER |