Individual
JACK T EVJY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10 WILLARD ST, QUINCY, MA 02169-1281
(617) 479-1452
(617) 479-3500
Mailing address
10 WILLARD ST, QUINCY, MA 02169-1281
(617) 479-1437
(617) 479-3500
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
27139
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14331
HARVARD PILGRIM
MA
05
—
2093472
—
MA
01
—
27139
TUFTS HEALTH CARE
MA
01
—
92915
AETNA US HEALTH
MA
01
—
M07140
BLUE CROSS BLUE SHIELD
MA
Enumeration date
11/18/2005
Last updated
01/21/2014
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