Provisor, Evan Paul
Provisor, Evan Paul is an individual health care provider with primary practice located at 94 South St , Southbridge MA 01550-4000. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Provisor, Evan Paul can be contacted via phone (508) 764-6966.Contact Information
Primary practice address
94 South St
Southbridge MA 01550-4000
Phone: (508) 764-6966
Fax: (508) 764-2457
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 237945 | Massachusetts |
Profile Details
| NPI number | 1366427429 |
|---|---|
| LBN Legal business name | Provisor, Evan Paul |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 13th, 2005 |
| Last updated | Dec 21st, 2011 - about 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366427429 | NPPES |
| Massachusetts | MEDICAID | 2160307 |
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