MEDICARE: KAREN BACON EVANS M.D.

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	208D00000X	General Practice Physician	ME99690	FL
2	207L00000X	Anesthesiology Physician	ME99690	FL

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

General Provider Information

NPI Number	:	1366625212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN BACON EVANS M.D.

Provider Business Mailing Address
First Line	:	1307 N LAKE HOWARD DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-3127
Country	:	US
Telephone Number	:	407-203-0936
Fax Number	:

Provider Business Practice Location Address
First Line	:	6735 CONROY WINDERMERE RD
Second Line	:	STE 314
City	:	ORLANDO
State	:	FL
Zip	:	32835-3565
Country	:	US
Telephone Number	:	407-203-0936
Fax Number	:

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

Provider Enumeration Date	:	12/14/2007
Last Update Date	:	10/02/2015

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