Organization
EVERNORTH MEDICAL CARE PROVIDERS NEW YORK PROFESSIONAL CORPORATION
Active
Other names
Dirk Wales MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE D LAKES (SENIOR PARALEGAL)
(954) 446-0640
Entity
Organization
Contact information
Practice address
555 BROADHOLLOW RD STE 305, MELVILLE, NY 11747-5018
(773) 292-4800
(312) 564-4059
Mailing address
730 COOL SPRINGS BLVD STE 500, FRANKLIN, TN 37067-7331
(773) 292-4800
(312) 564-4059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
213E00000X
Podiatrist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/08/2014
Last updated
07/14/2025
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