Healthcare Provider Details

I. General information

NPI: 1265575922
Provider Name (Legal Business Name): CURTIS C. EVENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E SEMINOLE ST
SPRINGFIELD MO
65804-2227
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2064
  • Fax: 417-820-8716
Mailing address:
  • Phone: 417-829-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number100452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: