Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME90771 | FL |
NPI | 1003892290 |
---|---|
Provider Name | Dr. Paul John Evans |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 11/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01229 | BC/BS (01) | FL |
0733537 | CIGNA (01) | |
272204600 | (05) | FL |
287091 | STAYWELL/HEALTHEASE (01) | |
297317 | AVMED (01) | |
4122038 | AETNA (01) | |
T40667 | (02) | FL |