Basic Information
| Provider Information | |||||||||
| NPI: | 1942203377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERSON | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 WOODMAN DR | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454321400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137349200 | ||||||||
| FaxNumber: | 5137349300 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 W PLANE ST | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451068339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137349200 | ||||||||
| FaxNumber: | 5137349300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-063130 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35-063130 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 110247626 | 01 | RR MEDICARE | OTHER | 0888777 | 05 | OH | MEDICAID | P00789615 | 01 | OH | RR MEDICARE | OTHER |