Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G55686 | CA |
NPI | 1407952427 |
---|---|
Provider Name | David Gary Evans |
First Address | Vista, CA 92084-3640 |
Second Address | Vista, CA 92081-6642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E93248 | (02) | CA |