Provider Demographics
NPI:1023203874
Name:RICHARD M. EVANS, D.P.M., P.C.
Entity Type:Organization
Organization Name:RICHARD M. EVANS, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-474-4766
Mailing Address - Street 1:3401 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1541
Mailing Address - Country:US
Mailing Address - Phone:402-474-4766
Mailing Address - Fax:402-474-5957
Practice Address - Street 1:3401 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1541
Practice Address - Country:US
Practice Address - Phone:402-474-4766
Practice Address - Fax:402-474-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE132213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091287OtherMEDICARE
NE091287OtherMEDICARE
NE=========Medicaid
NE=========OtherRR MEDICARE
NE=========OtherMIDLANDS
NE=========Medicaid