Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G65618 | CA |
Y | 207YP0228X | Pediatric Otolaryngology | G65618 | CA |
NPI | 1346243011 |
---|---|
Provider Name | Dr. David A Evans |
First Address | Sacramento, CA 95815-4314 |
Second Address | Sacramento, CA 95815-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040003544 | RR MEDICARE PIN (01) | CA |
E66336 | (02) | CA |