Provider Demographics
NPI:1285724989
Name:EVANS, ERIC A (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER DT
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:1380 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-251-1000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT356126-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107008375103OtherIHC
ID806732000Medicaid
UTQM0000075886OtherALTIUS
WY118901800Medicaid
UT1502954OtherUMWA
UT870545614EEVOtherEDUCATORS MUTUAL
AZ450601001Medicaid
UTPRA02635OtherMOLINA
UT99459OtherHEALTHY U
NV002086317Medicaid
UT71448OtherPEHP
UT2090168OtherUNITED HEALTHCARE
UT345738OtherDESERET MUTUAL
UT870545614EEVOtherEDUCATORS MUTUAL
UTG68823Medicare UPIN
UT005532789Medicare ID - Type Unspecified