Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35044785 | OH |
Y | 208600000X | Surgeon | 35044785 | OH |
NPI | 1013991702 |
---|---|
Provider Name | Dr. Darrell Kennedy Evans JR. |
First Address | Maumee, OH 43537-1839 |
Second Address | Maumee, OH 43537-1839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0439814 | (05) | OH |
0439817 | (05) | OH |
C01844 | (02) | OH |