Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 229904 | MA |
NPI | 1013068147 |
---|---|
Provider Name | Dr. Thomas Evans |
First Address | Worcester, MA 01605-2138 |
Second Address | Worcester, MA 01605-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |