MEDICARE: DR. RICHARD O EVANS MD

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	207Q00000X	Family Medicine Physician	22685	CO

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	:	1427024157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD O EVANS MD

Provider Business Mailing Address
First Line	:	2610 TENDERFOOT HILL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3981
Country	:	US
Telephone Number	:	719-576-3901
Fax Number	:	719-576-2025

Provider Business Practice Location Address
First Line	:	2610 TENDERFOOT HILL ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3981
Country	:	US
Telephone Number	:	719-576-3901
Fax Number	:	719-576-2025

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/23/2015

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