Individual
DR. MARK EVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S MAIN ST, TIPTON, IN 46072-9753
(765) 675-8521
(765) 675-8520
Mailing address
1000 S MAIN ST, TIPTON, IN 46072-9753
(765) 675-8521
(765) 675-8520
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01032279
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000603583
ANTHEM - TIPTON HOSPITAL
IN
05
—
100234260A
—
IN
Enumeration date
10/19/2005
Last updated
11/29/2011
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