Individual
DR. SAMUEL CHARLES EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
181 N KENTUCKY AVE STE 100, WEST PLAINS, MO 65775-2092
(417) 257-5911
(417) 257-5913
Mailing address
PO BOX 1100, WEST PLAINS, MO 65775-1100
(417) 256-9111
(417) 257-5947
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
2020012799
MO
207QA0505X
Adult Medicine Physician
C-8117
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200084697
—
MO
01
—
2020012799
STATE LICENSE
MO
Enumeration date
03/12/2013
Last updated
09/30/2020
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