Individual
SCOTT RANDALL EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6699 ALVARADO RD, SUITE 2100, SAN DIEGO, CA 92120-5238
(619) 229-3909
(619) 229-3902
Mailing address
6699 ALVARADO RD, SUITE 2100, SAN DIEGO, CA 92120-5238
(619) 229-3909
(619) 229-3902
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6002851-1205
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
A100151
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W12026
MEDICARE GROUP PTAN
CA
Enumeration date
03/28/2007
Last updated
08/24/2010
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