Active NPI
Evan Jonathan Wilson, IDC
- Independent Duty Corpsman
- Yuma, AZ
National Provider Identifier
1003298571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 2989 East Arow St
Yuma, AZ 85365 - Phone
- (310) 408-7127
- NPI assigned
- Jun 22, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
2989 East Arow St
Yuma, AZ 85365
Mailing address
1617 E Reilly St
Apt C
Yuma, AZ 85365-5659
Phone (310) 408-7127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124648471 | Other | CA | US NAVY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442361600000",
"number": "1003298571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1617 E REILLY ST",
"address_2": "APT C",
"city": "YUMA",
"state": "AZ",
"postal_code": "853655659",
"telephone_number": "310-408-7127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2989 EAST AROW ST",
"city": "YUMA",
"state": "AZ",
"postal_code": "85365",
"telephone_number": "310-408-7127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "EVAN",
"middle_name": "JONATHAN",
"name_prefix": "Mr.",
"credential": "IDC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-22",
"last_updated": "2015-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US NAVY",
"identifier": "1124648471",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.