Provider Demographics
NPI:1306819974
Name:EVANS, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-578-2480
Mailing Address - Fax:307-578-2492
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:STE 2D
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-2947
Practice Address - Fax:307-578-2492
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI276130202086S0129X
WYTL#11372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31513900Medicaid
WI13240Medicare ID - Type Unspecified
WI54455Medicare ID - Type Unspecified
WIE91931Medicare UPIN
WI15040Medicare ID - Type Unspecified
WI31513900Medicaid