MEDICARE: MARK WILLIAM EVANS M.D., M.S.P.H.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	A162363	CA

General Provider Information

NPI Number	:	1831622869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WILLIAM EVANS M.D., M.S.P.H.

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 SUTTER PL STE 203
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-6217
Country	:	US
Telephone Number	:	530-750-5880
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/26/2023

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