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Individual
DR. JONATHAN WALLACE EVANS
Active
Individual
DR. JONATHAN WALLACE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
43700
OR
207X00000X
Orthopaedic Surgery Physician
5101015261
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274339
—
OR
01
—
P00626446
MEDICARE RAILROAD
OR
01
—
R138023
MEDICARE PART B
OR
Enumeration date
02/22/2007
Last updated
06/26/2009
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