Provider Demographics
NPI:1811622368
Name:EVANS, DAVID II
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:EVANS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 BONNIE BRAE AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5212
Mailing Address - Country:US
Mailing Address - Phone:614-783-3173
Mailing Address - Fax:
Practice Address - Street 1:387 BONNIE BRAE AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5212
Practice Address - Country:US
Practice Address - Phone:614-783-3173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist