Provider Demographics
NPI:1427046549
Name:EVE, KATHLEEN LYNN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LYNN
Last Name:EVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:LYNN
Other - Last Name:HEMBREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1541 FLORIDA AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4429
Mailing Address - Country:US
Mailing Address - Phone:209-577-3388
Mailing Address - Fax:209-523-0764
Practice Address - Street 1:1541 FLORIDA AVE
Practice Address - Street 2:STE 200
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4429
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-523-0764
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020039793OtherRAILROAD MEDICARE
CACD069AOtherGROUP PTAN- MEDICARE
CACD166ZOtherINDIVIDUAL PTAN- MEDICARE
CAZZZ48224ZOtherMEDICARE IDENTIFICATION #