Provider Demographics
NPI:1760477640
Name:EVANS, DANIEL J (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
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 1:745 W STATE ST
Mailing Address - Street 2:STE 600
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1515
Mailing Address - Country:US
Mailing Address - Phone:614-228-2727
Mailing Address - Fax:614-228-8118
Practice Address - Street 1:745 W STATE ST
Practice Address - Street 2:STE 600
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1515
Practice Address - Country:US
Practice Address - Phone:614-228-2727
Practice Address - Fax:614-228-8118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34005271E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845554Medicaid
E55509Medicare UPIN
OH0845554Medicaid