Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 52498 | WI |
N | 2086X0206X | Surgical Oncologist | H5546 | TX |
NPI | 1295820116 |
---|---|
Provider Name | Douglas B. Evans |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 22/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295820116 | (05) | WI |
36457201 | (05) | TX |
C65513 | (02) |