Individual
THOMAS EDWIN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
11082 N RADIO STATION RD, SENECA, SC 29678-1142
(864) 882-2314
(864) 882-3677
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20498
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080165039
RAILROAD MEDICARE
SC
01
—
20-8715655
FACILITY TAX ID
SC
05
—
GP4697
—
SC
05
—
Q33321
—
SC
Enumeration date
07/13/2005
Last updated
09/03/2014
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