Individual
JORDAN BRADY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1950 E 54TH ST, DAVENPORT, IA 52807-2761
(563) 344-7546
(563) 344-1373
Mailing address
200 HAWKINS DR DEPT OF, IOWA CITY, IA 52242-1009
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
R-11746
IA
207ND0101X
MOHS-Micrographic Surgery Physician
MD-49996
IA
390200000X
Student in an Organized Health Care Education/Training Program
R-11746
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/19/2019
Last updated
10/10/2024
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