MEDICARE: DR. PAUL JOHN EVANS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME90771	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4122038	OTHER		AETNA
2	0733537	OTHER		CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	287091	OTHER		STAYWELL/HEALTHEASE
5	01229	OTHER	FL	BC/BS
6	297317	OTHER		AVMED

General Provider Information

NPI Number	:	1003892290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JOHN EVANS MD

Provider Business Mailing Address
First Line	:	2870 SE 45TH ST
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34480-7226
Country	:	US
Telephone Number	:	727-735-7575
Fax Number	:	727-892-8420

Provider Business Practice Location Address
First Line	:	2870 SE 45TH ST
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34480-7226
Country	:	US
Telephone Number	:	727-735-7575
Fax Number	:	727-892-8420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/07/2022

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