| Doctor Name: | DR. KEITH H EVANS |
| NPI Number: | 1033179049 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 1612791205 |
| Business Practice Address: | 1140 W 500 S Vernal, UT - 840782914 |
| Business Phone Number: | 4357896300 |
| Business Fax Number: | 4357896325 |
| Mailing Address: | 1140 W 500 S Ste 9, VERNAL |
| State: | UT |
| Postal Code: | 840782912 |
| Phone Number: | 4357896300 |
| Fax Number: | 4357896325 |
| NPI Enumeration Date: | 03/24/2006 |
| NPI Last Update Date: | 08/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1612791205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |