Provider Demographics
NPI:1255337770
Name:EVANS, RONALD DAVID (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
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:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:929 S TAMIAMI TRL STE 206
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9241
Practice Address - Country:US
Practice Address - Phone:941-261-2111
Practice Address - Fax:941-261-5912
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT114789208600000X
MS20423208600000X
FLME542802086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08678098Medicaid
FL060251500Medicaid
MS08678098Medicaid
P00670486Medicare PIN
FLC70693Medicare UPIN
MS512I020077Medicare PIN