Provider Demographics
NPI:1093726150
Name:EVANS, RICHARD MARCUS (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARCUS
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 O STREET
Mailing Address - Street 2:RICHARD M EVANS DPM
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 STREET
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE132213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T74861Medicare UPIN
NE091217Medicare ID - Type Unspecified