Provider Demographics
NPI:1801058227
Name:EVANS, ROBERT D (BSBCHIS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:EVANS
Suffix:
Gender:M
Credentials:BSBCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9156 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3148
Mailing Address - Country:US
Mailing Address - Phone:727-393-3775
Mailing Address - Fax:727-393-3113
Practice Address - Street 1:9156 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-3148
Practice Address - Country:US
Practice Address - Phone:727-393-3775
Practice Address - Fax:727-393-3113
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1373237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist