Basic Information
| Provider Information | |||||||||
| NPI: | 1992781843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERHART | ||||||||
| FirstName: | FLOYD | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 06/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 17201 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7617655 | 05 | NC | MEDICAID | 118190400 | 05 | WY | MEDICAID | 01172014 | 05 | CO | MEDICAID | 104693074 | 05 | MI | MEDICAID | 920737 | 05 | AZ | MEDICAID | XPY201231 | 05 | CA | MEDICAID | 300090119 | 01 | CO | RR MCRE RIA | OTHER | 84-059792913 | 05 | NE | MEDICAID | 300089926 | 01 | CO | RR MCRE MIC | OTHER | 020736 | 01 | CO | KAISER COMMERCIAL NUMBER | OTHER | 200418250A | 05 | KS | MEDICAID | 300089996 | 01 | CO | RR MCRE DIA | OTHER |