Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C1-0009397 | DE |
N | 207T00000X | Neurosurgeon | MD421165 | PA |
NPI | 1124048194 |
---|---|
Provider Name | Dr. James J. Evans |
First Address | Philadelphia, PA 19106-4404 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004278 | (05) | NJ |
100853341 | (05) | PA |