Individual
EDWARD E EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-6185
(208) 356-0378
Mailing address
15 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-6185
(208) 356-0378
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M10591
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001017396
BLUE SHIELD
ID
01
—
77955
BLUE CROSS
ID
05
—
808292100
—
ID
Enumeration date
05/04/2006
Last updated
01/22/2015
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