Healthcare Provider Details

I. General information

NPI: 1770678435
Provider Name (Legal Business Name): MARTIN EARL EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF KENTUCKY SCHOOL OF MEDICINE 800 ROSE ST.
LEXINGTON KY
40536-0298
US

IV. Provider business mailing address

571 LOWER HINES CREEK RD
RICHMOND KY
40475-8412
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-8178
  • Fax: 859-323-8926
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number29918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: