Provider Demographics
NPI:1346508793
Name:EVANS, RYAN SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-382-0221
Mailing Address - Fax:814-382-0231
Practice Address - Street 1:12387 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-4203
Practice Address - Country:US
Practice Address - Phone:814-382-0221
Practice Address - Fax:814-382-0231
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014474207R00000X
PAOS016739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine