Provider Demographics
NPI:1962467779
Name:EVANS, LAWRENCE MERLIN (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MERLIN
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:120 WARWICK ST L M EVANS PC
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801
Mailing Address - Country:US
Mailing Address - Phone:989-463-3937
Mailing Address - Fax:989-463-4694
Practice Address - Street 1:120 WARWICK ST
Practice Address - Street 2:L M EVANS PC
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-463-3937
Practice Address - Fax:989-463-4694
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007935207W00000X
MILE007935207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111558970Medicaid
MI155897311Medicaid
MI5592033Medicare ID - Type Unspecified
MIE37402Medicare PIN
E37402Medicare UPIN
MI5592033Medicare PIN
MI0769890001Medicare NSC