# MARK D BEVILL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1487182937
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | R-10846 | IA | — |
| 208800000X | Urology Physician | 01090017A | IN | Yes |
| 208800000X | Urology Physician | R-10846 | IA | — |

## Other

- **Enumeration date:** 05/30/2017
- **Last updated:** 03/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 064740078 | MEDICARE PTAN | IN |
| 01 | — | 1103128902 | ANTHEM PTAN | IN |
| 05 | — | 300077614 | — | IN |
| 01 | — | 815500654 | MEDICARE PTAN | IN |
| 01 | — | Q00573984 | RAILROAD PTAN | IN |