Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 0102204818 | VA |
N | 207YS0123X | Facial Plastic Surgeon | 5101020019 | MI |
NPI | 1609127059 |
---|---|
Provider Name | Dr. Michel Anthony Evans |
First Address | Danville, VA 24541-4160 |
Second Address | Danville, VA 24541-4160 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 28/03/2021 |