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Individual

GARY LEWIS EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
311 WEST FAIRCHILD STREET, DANVILLE, IL 61832
(217) 431-7650
Mailing address
PO BOX 6002, URBANA, IL 61803-6002
(217) 383-3311

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003219
IL
363AM0700X
Medical Physician Assistant
A419
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0533210001
DMERC
Enumeration date
07/26/2006
Last updated
03/07/2023
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