Provider Demographics
NPI:1144206947
Name:EVANS, JOSEPH CEDRIC JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CEDRIC
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:19101 E VALLEY VIEW PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6904
Mailing Address - Country:US
Mailing Address - Phone:816-254-9292
Mailing Address - Fax:816-795-8996
Practice Address - Street 1:19101 E VALLEY VIEW PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6904
Practice Address - Country:US
Practice Address - Phone:816-254-9292
Practice Address - Fax:816-795-8996
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD32823208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO04537013OtherBLUE CROSS-BLUE SHIELD
MO200010403Medicaid
MO2143248Medicare ID - Type Unspecified
MO200010403Medicaid