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Individual

DONALD L EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
530 S JACKSON ST, # C07, LOUISVILLE, KY 40202-1675
(502) 852-5875
(502) 852-1754
Mailing address
PO BOX 21249, LOUISVILLE, KY 40221-0249
(502) 581-1500
(502) 540-4959

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
14790
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000245967
ANTHEM
KY
05
64052673
KY
01
P00007346
RAILROAD MEDICARE
KY
Enumeration date
07/08/2005
Last updated
02/19/2008
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