Healthcare Provider Details

I. General information

NPI: 1720198880
Provider Name (Legal Business Name): ANTHONY C EVANS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 MOLL DR
WAUNAKEE WI
53597-9166
US

IV. Provider business mailing address

1105 MOLL DR
WAUNAKEE WI
53597-9166
US

V. Phone/Fax

Practice location:
  • Phone: 608-695-8862
  • Fax: 225-269-1249
Mailing address:
  • Phone: 608-695-8862
  • Fax: 225-269-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number311933
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD228837
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number39972-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: