Healthcare Provider Details

I. General information

NPI: 1982960324
Provider Name (Legal Business Name): LORAS R EVEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 SE 14TH ST
DES MOINES IA
50320-1846
US

IV. Provider business mailing address

6520 SE 14TH ST
DES MOINES IA
50320-1846
US

V. Phone/Fax

Practice location:
  • Phone: 515-256-4242
  • Fax: 515-953-2137
Mailing address:
  • Phone: 414-257-8577
  • Fax: 515-953-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61731
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-05409
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: