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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144319039 NPPES
California MEDICAID 00A221030

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