Provider Demographics
NPI:1881646768
Name:EVANSON, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:EVANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-7930
Mailing Address - Fax:218-249-7999
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-7930
Practice Address - Fax:218-249-7999
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN38517207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN167714400Medicaid
MN167714400Medicaid