Evans, Edward Theodore
Evans, Edward Theodore is an individual health care provider with primary practice located at 121 Sotoyome St , Santa Rosa CA 95405-4823. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Body Imaging, Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Diagnostic Ultrasound. Allopathic & Osteopathic Physicians / Body Imaging is his primary health care specialty. Evans, Edward Theodore can be contacted via phone (707) 546-4062.Contact Information
Primary practice address
121 Sotoyome St
Santa Rosa CA 95405-4823
Phone: (707) 546-4062
Fax: (707) 578-6258
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Body Imaging | 2085B0100X | A22103 | California |
| Allopathic & Osteopathic Physicians / Nuclear Radiology | 2085N0904X | A22103 | California |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | A22103 | California |
| Allopathic & Osteopathic Physicians / Diagnostic Ultrasound | 2085U0001X | A22103 | California |
Profile Details
| NPI number | 1144319039 |
|---|---|
| LBN Legal business name | Evans, Edward Theodore |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 11th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144319039 | NPPES |
| California | MEDICAID | 00A221030 |
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