Provider Demographics
NPI:1841432648
Name:PRICE, EVONNA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVONNA
Middle Name:
Last Name:PRICE
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 1:975 CORKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-4878
Mailing Address - Country:US
Mailing Address - Phone:954-922-7606
Mailing Address - Fax:954-985-0492
Practice Address - Street 1:140B S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DANIA
Practice Address - State:FL
Practice Address - Zip Code:33004-3623
Practice Address - Country:US
Practice Address - Phone:954-922-7606
Practice Address - Fax:954-985-0492
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68543207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252759600Medicaid
FL252759600Medicaid