Healthcare Provider Details

I. General information

NPI: 1023203874
Provider Name (Legal Business Name): RICHARD M. EVANS, D.P.M., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 O ST
LINCOLN NE
68510-1541
US

IV. Provider business mailing address

3401 O ST
LINCOLN NE
68510-1541
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-4766
  • Fax: 402-474-5957
Mailing address:
  • Phone: 402-474-4766
  • Fax: 402-474-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number132
License Number StateNE

VIII. Authorized Official

Name: DR. RICHARD MARCUS EVANS
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 402-474-4766