Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD61120255 | WA |
NPI | 1063807477 |
---|---|
Provider Name | Evan Carlos |
First Address | Spokane, WA 99202-2902 |
Second Address | Spokane, WA 99202-2902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 14/10/2021 |