MEDICARE: BRAD A EVANS DO

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	34008200	OH
2	208M00000X	Hospitalist Physician	34008200	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225077803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD A EVANS DO

Provider Business Mailing Address
First Line	:	PO BOX 636256
Second Line	:	CENTRAL CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-5505
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	7700 UNIVERSITY DR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2505
Country	:	US
Telephone Number	:	513-298-7325
Fax Number	:	513-298-7406

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/11/2020

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Directions to “ BRAD A EVANS DO” Practice Location

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