Provider Demographics
NPI:1942408844
Name:EVANS, JEANNIE D (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:D
Last Name:EVANS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2650 E SHOW LOW LK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7955
Mailing Address - Country:US
Mailing Address - Phone:928-537-4300
Mailing Address - Fax:
Practice Address - Street 1:2650 E SHOW LOW LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7955
Practice Address - Country:US
Practice Address - Phone:928-537-4300
Practice Address - Fax:928-537-4320
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2016-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ005387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ142329Medicare PIN