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Individual

DR. JONATHAN S. EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3600
(904) 697-3927
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945

Taxonomy

Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
ME0051197
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000446531A
GA
05
61882900
FL
Enumeration date
08/10/2006
Last updated
05/07/2013
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