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Individual

DR. JONATHAN WALLACE EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
3680 NW SAMARITAN DR, CORVALLIS, OR 97330-3737
(541) 754-1276
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 754-1276

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
43700
OR
207X00000X
Orthopaedic Surgery Physician
5101015261
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
274339
OR
01
P00626446
MEDICARE RAILROAD
OR
01
R138023
MEDICARE PART B
OR
Enumeration date
02/22/2007
Last updated
06/26/2009
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