Provider Demographics
NPI:1063406056
Name:EVANS, CLIFFORD L (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:L
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLIFFORD
Other - Middle Name:L
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-0905
Mailing Address - Country:US
Mailing Address - Phone:501-354-9746
Mailing Address - Fax:501-354-0553
Practice Address - Street 1:912 E DRILLING ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-2218
Practice Address - Country:US
Practice Address - Phone:501-354-9746
Practice Address - Fax:501-354-0553
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC3306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR020548706OtherTHE PRUDENTAL-AARP CLAIMS
AR080191177OtherPALMETTO GBA
AR121959001Medicaid
AR4099493OtherAETNA
AR51594OtherBC/BS
AR020548706OtherFIRST HEALTH
ARA37553OtherCIGNA HEALTHCARE
AR0100555OtherUNITED HEALTH CARE
AR020548706OtherTRICARE
AR020548706OtherAMCO
AR02120016500OtherQUALCHOICE
ARA37553OtherCIGNA HEALTHCARE
AR51594Medicare ID - Type Unspecified