Evans, Jack C

Evans, Jack C is an individual health care provider with primary practice located at 1440 Jefferson St , Laurel MS 39440-4243. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Evans, Jack C can be contacted via phone (601) 428-0577.

Contact Information

Primary practice address
1440 Jefferson St Laurel MS 39440-4243
Phone: (601) 428-0577
Fax: (601) 649-7962
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 09103 Mississippi

Profile Details

NPI number 1396784187
LBN Legal business name Evans, Jack C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Feb 11th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396784187 NPPES
Mississippi MEDICAID 00014780

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