Individual
JACK L EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
629 N SANDUSKY AVE, BUCYRUS, OH 44820-1821
(419) 562-4677
(419) 562-0987
Mailing address
32 WALKER ST, TIFFIN, OH 44883-3030
(419) 842-4336
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35044381
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316691
BCBS # FOR BUCYRUS
OH
01
—
000000382640
BCBS
OH
05
—
0464180
—
OH
01
—
POO328458
RAILROAD MEDICARE
—
Enumeration date
04/21/2006
Last updated
12/27/2007
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