Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | J4103 | TX |
NPI | 1033188800 |
---|---|
Provider Name | William R Evans |
First Address | Stephenville, TX 76401-0014 |
Second Address | Stephenville, TX 76401-3548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 14/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
031323102 | (05) | TX |
G74384 | (02) | TX |