Provider Demographics
NPI:1942292446
Name:EVANS, BRUCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1160 EAST 3900 SOUTH
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1275
Mailing Address - Country:US
Mailing Address - Phone:801-262-8486
Mailing Address - Fax:801-284-8699
Practice Address - Street 1:1160 EAST 3900 SOUTH
Practice Address - Street 2:SUITE 5000
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1275
Practice Address - Country:US
Practice Address - Phone:801-262-8486
Practice Address - Fax:801-284-8699
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2011-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT1684391205207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870682101009Medicaid
UTD0774Medicaid
UT4415240001Medicare NSC
UTD0774Medicaid
UT005590508Medicare PIN