Provider Demographics
NPI:1992781843
Name:EVERHART, FLOYD R JR (MD)
Entity type:Individual
Prefix:DR
First Name:FLOYD
Middle Name:R
Last Name:EVERHART
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE
Mailing Address - Street 2:NO 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2702
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7617655Medicaid
WY118190400Medicaid
CO01172014Medicaid
MI104693074Medicaid
AZ920737Medicaid
CAXPY201231Medicaid
CO300090119OtherRR MCRE RIA
NE84-059792913Medicaid
CO300089926OtherRR MCRE MIC
CO020736OtherKAISER COMMERCIAL NUMBER
KS200418250AMedicaid
CO300089996OtherRR MCRE DIA
NE84-059792913Medicaid
AZ920737Medicaid
KS200418250AMedicaid
CO300089996OtherRR MCRE DIA
CO300090119OtherRR MCRE RIA