Provider Demographics
NPI:1982816708
Name:ROBERT A. EVANS
Entity Type:Organization
Organization Name:ROBERT A. EVANS
Other - Org Name:MIDDLEFIELD PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-632-0770
Mailing Address - Street 1:16030 E HIGH ST
Mailing Address - Street 2:PO BOX 1027
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9474
Mailing Address - Country:US
Mailing Address - Phone:440-632-0770
Mailing Address - Fax:440-632-0321
Practice Address - Street 1:16030 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9474
Practice Address - Country:US
Practice Address - Phone:440-632-0770
Practice Address - Fax:440-632-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001271E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0226384Medicaid
OHR09307911Medicare ID - Type Unspecified