Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 25MB10327900 | NJ |
NPI | 1174937395 |
---|---|
Provider Name | Daniel Evering JR. |
First Address | Marlton, NJ 08053-3126 |
Second Address | Vineland, NJ 08360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 02/07/2018 |