Individual
DAVID EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
40922
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1207847
MEDICA
—
01
—
37B80EV
BLUE CROSS BLUE SHIELD
MN
01
—
CP9021019203
PREFERRED ONE
—
Enumeration date
07/28/2006
Last updated
07/08/2007
Update your record
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