Healthcare Provider Details

I. General information

NPI: 1972245157
Provider Name (Legal Business Name): ARTHUR CHARLES EVENSEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E GAINES DR
CLINTON MO
64735-3205
US

IV. Provider business mailing address

603 E GAINES DR
CLINTON MO
64735-3205
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-8171
  • Fax:
Mailing address:
  • Phone: 660-885-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2025006410
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: