# EVAN T BELFER MD SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184927303
- **Authorized official:** DR. EVAN T BELFER MD (PRESIDENT)
- **Authorized official phone:** (618) 687-2319

## Contact information

- **Practice address:** 801 N 14TH ST, MURPHYSBORO, IL 62966-1611
- **Practice address phone:** (618) 687-2319
- **Practice address fax:** (618) 684-3321
- **Mailing address:** 801 N 14TH ST, MURPHYSBORO, IL 62966-1611
- **Mailing address phone:** (618) 687-2319
- **Mailing address fax:** (618) 684-3321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036-107906 | IL | Yes |

## Other

- **Enumeration date:** 12/09/2010
- **Last updated:** 09/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036-107906 | — | IL |
| 01 | — | 039-32006 | BLUECROSS BLUESHIELD | IL |
| 01 | — | 078338 | HEALTH ALLIANCE | IL |
| 01 | — | 080191627 | RAILROAD MEDICARE | IL |
| 01 | — | 431741 | HEALTHLINK | IL |
| 01 | — | 614634500 | DEPARTMENT OF LABOR | IL |