Basic Information
Provider Information
NPI: 1114661774
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALEXANDER
FirstName: EVELYN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 N CAMPBELL AVE
Address2: PO BOX 245058
City: TUCSON
State: AZ
PostalCode: 85724
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1501 N CAMPBELL AVE
Address2:  
City: TUCSON
State: AZ
PostalCode: 857240001
CountryCode: US
TelephoneNumber: 5206267747
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2022
LastUpdateDate: 04/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XR79283AZY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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