Provider Demographics
NPI:1710969522
Name:EVANS, DON ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:ALAN
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 1:420 LOWELL DR SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5954
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-535-5976
Practice Address - Fax:256-535-5953
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004050364OtherAETNA
410013838OtherRAILROAD MEDIARE
AL000004303Medicaid
630817103OtherTAX IDENTIFICATION NO
AL51004303OtherBLUE CROSS BLUE SHIELD
410013838OtherRAILROAD MEDIARE
AL000004303Medicaid