Provider Demographics
NPI:1356348080
Name:EVANS, CHESTER A (DPM)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:A
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6628
Mailing Address - Country:US
Mailing Address - Phone:305-899-3250
Mailing Address - Fax:305-899-3253
Practice Address - Street 1:893 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5711
Practice Address - Country:US
Practice Address - Phone:305-893-9366
Practice Address - Fax:305-893-4408
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1231213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT88551Medicare UPIN
FL87678ZMedicare ID - Type Unspecified