Individual
DR. VAN EVANOFF JR.
Active
Individual
DR. VAN EVANOFF JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
01053652A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000338733
BLUE CROSS & BLUE SHIELD
IN
05
—
200262220
—
IN
01
—
P01625340
RAILROAD MEDICARE
IN
Enumeration date
05/31/2005
Last updated
05/25/2016
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