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General NPI Number Information
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NPI Number | 1477733574
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Entity Type | Individual
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Provider Name | CAMERON J EVANS MD
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Gender | Male
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 700 LINCOLN ST STE 100
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City | KELSO
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State | WA
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Zip | 98626-1062
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Country | US
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Telephone | 360-425-5131
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Fax | 360-425-5509
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD61582833
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 6351865-8905
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License Number State | UT
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