Healthcare Provider Details

I. General information

NPI: 1265443295
Provider Name (Legal Business Name): JAMES LOWELL EVERETTE, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S STATE ST
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7050
  • Fax: 302-744-7682
Mailing address:
  • Phone: 302-744-7050
  • Fax: 302-744-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC1-0002933
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: