Individual
GREGORY EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8158
(251) 690-8853
Mailing address
PO BOX 2867, MOBILE, AL 36652-2867
(251) 690-8158
(251) 690-8853
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14380
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP PAYEE NUMBER
AL
01
—
1063439065
SITE GROUP PAYEE NUMBER
AL
05
—
631300001
—
AL
Enumeration date
07/25/2006
Last updated
05/06/2008
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