Provider Demographics
NPI:1013548056
Name:EVANS, EVAN DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:DAVID
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-222-1900
Mailing Address - Fax:602-557-0002
Practice Address - Street 1:1313 E OSBORN RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5688
Practice Address - Country:US
Practice Address - Phone:602-222-1900
Practice Address - Fax:602-266-3870
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MAPA9014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant