Provider Demographics
NPI:1144371618
Name:JOAN D. EVANS, D.P.M., P.A.
Entity type:Organization
Organization Name:JOAN D. EVANS, D.P.M., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:910-576-2212
Mailing Address - Street 1:433 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2849
Mailing Address - Country:US
Mailing Address - Phone:910-576-2212
Mailing Address - Fax:910-576-2212
Practice Address - Street 1:433 WOOD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2849
Practice Address - Country:US
Practice Address - Phone:910-576-2212
Practice Address - Fax:910-576-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC264213ES0103X, 213ES0131X, 213EP1101X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0805GOtherBLUE CROSS BLUE SHIELD
NC890805GMedicaid
NCT82537Medicare UPIN
NC890805GMedicaid