Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 10892 | MS |
NPI | 1013057645 |
---|---|
Provider Name | Dr. Paula J Spence-Evans |
First Address | Greenwood, MS 38935-1410 |
Second Address | Greenwood, MS 38930-4030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00014115 | (05) | MS |
09012361 | (05) | MS |
09013096 | (05) | MS |
B31043 | (02) | MS |