Organization
VITALITY INTERNAL MEDICINE - AVONDALE PLLC
Active
Other names
Men's Vitality Center, Vitality Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BENJAMIN EVANS II MD (MEDICAL DIRECTOR)
(602) 791-9112
Entity
Organization
Contact information
Practice address
10320 W MCDOWELL RD STE E5015, AVONDALE, AZ 85392-4869
(602) 791-9112
Mailing address
111 E DUNLAP AVE STE 1-193, PHOENIX, AZ 85020-7812
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37616
MEDICAL LICENSE
AZ
Enumeration date
04/17/2018
Last updated
03/07/2023
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