Individual
DR. CHARLES WAYNE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4704 HOEN AVE, SANTA ROSA, CA 95405-7824
(707) 546-7979
Mailing address
PO BOX 689, 440 OAK STREET, PENNGROVE, CA 94951-0689
(707) 795-2175
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G46087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G460870
—
CA
Enumeration date
11/27/2006
Last updated
07/08/2007
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