Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 15258R | LA |
Y | 2086S0120X | Pediatric Surgery | ME116067 | FL |
NPI | 1548271067 |
---|---|
Provider Name | Evans Pierre Valerie |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018413600 | (05) | FL |
1165255 | (05) | LA |
H94953 | (02) |