MEDICARE: DR. DAVID EVELYN 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	207Q00000X	Family Medicine Physician	174739	NY

General Provider Information

NPI Number	:	1174524672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID EVELYN MD

Provider Business Mailing Address
First Line	:	1 FOX CARE DR
Second Line	:	SUITE 308
City	:	ONEONTA
State	:	NY
Zip	:	13820-2086
Country	:	US
Telephone Number	:	607-432-1163
Fax Number	:	607-431-5367

Provider Business Practice Location Address
First Line	:	1 FOX CARE DR
Second Line	:	SUITE 308
City	:	ONEONTA
State	:	NY
Zip	:	13820-2086
Country	:	US
Telephone Number	:	607-432-1163
Fax Number	:	607-431-5367

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID EVELYN MD” Practice Location

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