Provider Demographics
NPI:1932183456
Name:LEDERMAN, EVAN S (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:S
Last Name:LEDERMAN
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 1:2222 E HIGHLAND AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4872
Mailing Address - Country:US
Mailing Address - Phone:602-277-6211
Mailing Address - Fax:866-846-8709
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:STE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-277-6211
Practice Address - Fax:866-846-8709
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ24539207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ363979Medicaid
AZG05485Medicare UPIN
AZZ26617Medicare PIN