Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD20110 | OR |
N | 208600000X | Surgeon | MD20110 | OR |
Y | 208200000X | Surgeon | MD60653027 | WA |
Y | 208600000X | Surgeon | MD60653027 | WA |
N | 2086S0102X | Surgical Critical Care | MD20110 | OR |
N | 2086S0102X | Surgical Critical Care | MD60653027 | WA |
NPI | 1063527471 |
---|---|
Provider Name | Joseph Mark Evans |
First Address | Lakewood, WA 98499-3051 |
Second Address | Lakewood, WA 98499-3051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2002482 | (05) | WA |
E56161 | (02) |