MEDICARE: RACHAEL C EVANS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	UO3605	FL
2	208000000X	Pediatrics Physician	60736	MN
3	208000000X	Pediatrics Physician	OS16064	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225479983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL C EVANS DO

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:	904-450-6017
Fax Number	:	904-450-6041

Provider Business Practice Location Address
First Line	:	3200 3RD ST S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6096
Country	:	US
Telephone Number	:	904-450-7050
Fax Number	:	904-450-7059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	03/30/2023

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Directions to “ RACHAEL C EVANS DO” Practice Location

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