Provider Demographics
NPI:1104054378
Name:EVANS, NATHANIEL D (DO)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:D
Last Name:EVANS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2424 N. WYATT DRIVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-545-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:5750 E. HIGHWAY 90
Practice Address - Street 2:SUITE 300A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-8075
Practice Address - Fax:520-458-0339
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2015-08-14
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Provider Licenses
StateLicense IDTaxonomies
AZ6079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ808956Medicaid