MEDICARE: DR. RICHARD C. 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	207Q00000X	Family Medicine Physician	MD15316	OR

General Provider Information

NPI Number	:	1730115551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C. EVANS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1193
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-1193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 N MAIN ST
Second Line	:
City	:	LEBANON
State	:	OR
Zip	:	97355-2870
Country	:	US
Telephone Number	:	541-451-7940
Fax Number	:	541-451-1950

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	11/10/2020

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