MEDICARE: DR. JAYSON LEE EVERSGERD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	044170	CT

General Provider Information

NPI Number	:	1740234251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYSON LEE EVERSGERD D.O.

Provider Business Mailing Address
First Line	:	100 GRAND ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-2016
Country	:	US
Telephone Number	:	860-224-5675
Fax Number	:	860-224-5774

Provider Business Practice Location Address
First Line	:	1028 FORUM DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-8060
Country	:	US
Telephone Number	:	774-284-0496
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/31/2024

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