Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 5101008000 | MI |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5101008000 | MI |
NPI | 1154509172 |
---|---|
Provider Name | John Herbert Evans |
First Address | Saginaw, MI 48604-2329 |
Second Address | Saginaw, MI 48604-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2008 |
Last Update Date | 17/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5304000283 | DRUG TREATMENT PROGRAM PRESCRIBER (01) | MI |