Individual
DR. JOHN ELLIS EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
456 RIVER ROAD, FAYETTE, MS 39069
(601) 786-0443
Mailing address
404 JENNINGS ST, SUMNER, MS 38957-9720
(321) 720-0574
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05736
MS
207X00000X
Orthopaedic Surgery Physician
05736
MS
Other
Enumeration date
06/11/2010
Last updated
06/11/2010
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