Provider Demographics
NPI:1912955329
Name:MINARD, EVAN ENLOE (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:ENLOE
Last Name:MINARD
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:13631 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-7051
Practice Address - Country:US
Practice Address - Phone:303-252-2960
Practice Address - Fax:303-252-2964
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0052063207P00000X
TXL7049207P00000X
NMMD2012-0876207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160593301Medicaid
TXP00320503Medicare PIN
TXP00071490Medicare PIN
TX8F2739Medicare PIN
TXH75783Medicare UPIN
TX8A9380Medicare PIN
TX160593301Medicaid