MEDICARE: DONALD DOYLE EVANS PH.D.

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	103TC0700X	Clinical Psychologist	00736	IA

General Provider Information

NPI Number	:	1760673008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD DOYLE EVANS PH.D.

Provider Business Mailing Address
First Line	:	9600 TANGLEWOOD DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-1366
Country	:	US
Telephone Number	:	515-251-8626
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 NW 138TH ST
Second Line	:	STE 200
City	:	CLIVE
State	:	IA
Zip	:	50325-8377
Country	:	US
Telephone Number	:	515-223-7363
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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