Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 1O | LA |
NPI | 1184196784 |
---|---|
Provider Name | Evan Phillips |
First Address | Lafayette, LA 70508-6546 |
Second Address | Lafayette, LA 70508-5783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2018 |
Last Update Date | 19/12/2018 |