Individual
CLIFFORD J EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3512 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 776-3100
(765) 453-8165
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
02003895A
IN
207X00000X
Orthopaedic Surgery Physician
1985
TN
207X00000X
Orthopaedic Surgery Physician
H0070460
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201066810
—
IN
01
—
P01270939
RR MEDICARE
IN
Enumeration date
01/09/2007
Last updated
01/02/2024
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