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General NPI Number Information
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NPI Number | 1982816708
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Entity Type | Organization
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Legal Business Name | ROBERT A. EVANS
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 16030 E HIGH ST
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City | MIDDLEFIELD
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State | OH
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Zip | 44062-9474
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Country | US
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Telephone | 440-632-0770
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Fax | 440-632-0321
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Provider Business Mailing Address
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Address Line | 16030 E HIGH ST PO BOX 1027
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City | MIDDLEFIELD
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State | OH
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Zip | 44062-9474
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Country | US
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Telephone | 440-632-0770
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Fax | 440-632-0321
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A. EVANS
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Credential | D.O.
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Telephone | 440-632-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34001271E
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License Number State | OH
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