Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 18874 | MS |
N | 2084N0600X | Clinical Neurophysiologist | 18874 | MS |
NPI | 1619913761 |
---|---|
Provider Name | Dr. William J Evans |
First Address | Ocean Springs, MS 39564-5702 |
Second Address | Ocean Springs, MS 39564-5702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 23/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01257147 | (05) | MS |
13000350 | (02) | |
646000515 | COMMERCIAL (01) | |
646000515 | DEPARTMENT OF LABOR (01) | |
P00389398 | RAILROAD MEDICARE (01) |