Basic Information
| Provider Information | |||||||||
| NPI: | 1700244639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 BODIN CIR BLDG 777 | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078165930 | ||||||||
| FaxNumber: | 7078165665 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 BODIN CIR BLDG 777 | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078165930 | ||||||||
| FaxNumber: | 7078165665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2016 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10066115 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101263338 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 0101263338 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.