Evans, Jerry C

Evans, Jerry C is an individual health care provider with primary practice located at 420 E Division St , Fond Du Lac WI 54935-4560. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Evans, Jerry C can be contacted via phone (920) 926-8570.

Contact Information

Primary practice address
420 E Division St Fond Du Lac WI 54935-4560
Phone: (920) 926-8570
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 35746 Wisconsin

Profile Details

NPI number 1376534941
LBN Legal business name Evans, Jerry C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Dec 9th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376534941 NPPES
Wisconsin Other 110143294 RAILROAD MEDICARE
Wisconsin MEDICAID 32323200 RAILROAD MEDICARE

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