Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01080413A | IN |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 01080413A | IN |
NPI | 1073741237 |
---|---|
Provider Name | Dr. Brian John Evanson |
First Address | Munster, IN 46321-2811 |
Second Address | Munster, IN 46321-2811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 27/01/2022 |