Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME84903 | FL |
NPI | 1114985884 |
---|---|
Provider Name | Evan M Packer |
First Address | Delray Beach, FL 33445 |
Second Address | Delray Beach, FL 33445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 06/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I44764 | (02) | FL |