Healthcare Provider Details

I. General information

NPI: 1871591768
Provider Name (Legal Business Name): DOUGLAS EUGENE EVANS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

IV. Provider business mailing address

711 N 36TH ST
SAINT JOSEPH MO
64506-2977
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-4022
  • Fax: 816-271-4020
Mailing address:
  • Phone: 816-271-4022
  • Fax: 816-271-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110143
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: