Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | OS006561L | PA |
NPI | 1003803099 |
---|---|
Provider Name | Richard G Evans |
First Address | Lemoyne, PA 17043-1440 |
Second Address | Lemoyne, PA 17043-1440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011894370002 | (05) | PA |
E52958 | (02) | PA |