Provider Demographics
NPI:1649614108
Name:EVANGELISTA, PERRY JAYMES (MD)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JAYMES
Last Name:EVANGELISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5495
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5495
Mailing Address - Country:US
Mailing Address - Phone:480-656-0291
Mailing Address - Fax:480-656-0127
Practice Address - Street 1:3271 N CIVIC CENTER PLZ STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6990
Practice Address - Country:US
Practice Address - Phone:480-656-0291
Practice Address - Fax:480-656-0127
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56465207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1Medicaid
NY1114Medicare UPIN
NY1105Medicare PIN
NY1Medicaid
NY1122334455Medicare NSC