Provider Demographics
NPI:1215965405
Name:EVANS, PETER JOHN (MD, PHD, FAAOS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:EVANS
Suffix:
Gender:
Credentials:MD, PHD, FAAOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SE SALERNO RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6503
Mailing Address - Country:US
Mailing Address - Phone:772-223-5700
Mailing Address - Fax:727-223-5709
Practice Address - Street 1:2150 SE SALERNO RD STE 110
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6572
Practice Address - Country:US
Practice Address - Phone:772-781-2735
Practice Address - Fax:727-781-2739
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079068E207X00000X
FL143787207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2223874Medicaid
OH2223874Medicaid
OHEV7349441Medicare PIN