Provider Demographics
NPI:1952593998
Name:CONDEE, EVAN FRANKLIN (DO)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:FRANKLIN
Last Name:CONDEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:105 STATE HIGHWAY 1947
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6825
Practice Address - Country:US
Practice Address - Phone:606-475-0152
Practice Address - Fax:606-474-0040
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2187207Q00000X
OH34.010170207Q00000X
KY03295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100127960Medicaid
WV3810018911Medicaid
OH3077709Medicaid
KY7100127960Medicaid