Provider Demographics
NPI:1295962611
Name:C BENJAMIN EVANS MD LLC
Entity type:Organization
Organization Name:C BENJAMIN EVANS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:EVANS II
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-791-9112
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:STE. B3A-129
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:602-791-9112
Mailing Address - Fax:480-306-6712
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:STE. 270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:602-791-9112
Practice Address - Fax:480-306-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty