Healthcare Provider Details

I. General information

NPI: 1942798053
Provider Name (Legal Business Name): DANIEL EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 11/26/2021
Certification Date: 11/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

LINN COUNTY EMERGENCY MEDICINE P.C. 701 10TH ST SE
CEDAR RAPIDS IA
52403
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-4451
  • Fax: 317-718-6740
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01082622A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11019751A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-48222
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: