Individual
JERRY C EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8570
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
35746
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110143294
RAILROAD MEDICARE
WI
05
—
32323200
—
WI
Enumeration date
11/02/2005
Last updated
12/09/2020
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