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General NPI Number Information
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NPI Number | 1750648754
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Entity Type | Individual
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Provider Name | STEPHEN DANIEL EVANS D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 234 GOODMAN ST
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City | CINCINNATI
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State | OH
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Zip | 45219-2364
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Country | US
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Telephone | 513-584-4505
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Fax | 513-584-0468
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Provider Business Mailing Address
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Address Line | 2801 N GANTENBEIN AVE PO BOX 3777
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City | PORTLAND
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State | OR
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Zip | 97208-3777
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Country | US
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Telephone | 503-413-8407
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Fax | 503-413-6951
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.054872
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO182381
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License Number State | OR
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