Individual
JUSTON D EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804
(417) 347-1078
(417) 347-1079
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-1078
(417) 347-1078
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2004016881
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200060210A
—
OK
05
—
200332410A
—
KS
05
—
207350703
—
MO
01
—
P00235909
RR MEDICARE
—
Enumeration date
05/25/2006
Last updated
10/18/2007
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