Individual
DR. JACK C EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1440 JEFFERSON ST, LAUREL, MS 39440-4243
(601) 428-0577
(601) 649-7962
Mailing address
PO BOX 247, LAUREL, MS 39441-0247
(601) 399-6167
(601) 399-6281
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
09103
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014780
—
MS
Enumeration date
06/06/2006
Last updated
02/11/2014
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