Evans, Jonathan G
Evans, Jonathan G is an individual health care provider with primary practice located at 100 Foden Rd Ste 103 , South Portland ME 04106-2327. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pulmonary Disease, Allopathic & Osteopathic Physicians / Sleep Medicine. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Evans, Jonathan G can be contacted via phone (207) 828-1122.Contact Information
Primary practice address
100 Foden Rd Ste 103
South Portland ME 04106-2327
Phone: (207) 828-1122
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | MD27860 | Maine |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 207RS0012X | 24656 | Tennessee |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | MD0000024656 | Tennessee |
Profile Details
| NPI number | 1568460640 |
|---|---|
| LBN Legal business name | Evans, Jonathan G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2005 |
| Last updated | Feb 12th, 2024 - about 7 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568460640 | NPPES |
| Tennessee | Other | 621632725 | TAX ID |
| Tennessee | MEDICAID | 64014905 | TAX ID |
| Tennessee | MEDICAID | 3076519 | TAX ID |
| Tennessee | Other | 621701777 | TAX ID |
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