Provider Demographics
NPI:1174515910
Name:EVANS, DAVID K (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 AVENUE F NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-292-4004
Mailing Address - Fax:863-292-4005
Practice Address - Street 1:200 AVENUE F NE STE 9118
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-297-1777
Practice Address - Fax:863-297-1756
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94849208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35006OtherBCBS
FL274544500Medicaid
FL35006VMedicare PIN
FL35006XMedicare PIN
FLF27141Medicare UPIN
FL35006ZMedicare PIN
FL35006OtherBCBS
FL35006YMedicare PIN
FL35006UMedicare PIN
FL35006WMedicare PIN