Healthcare Provider Details

I. General information

NPI: 1871609388
Provider Name (Legal Business Name): WALTER JAMES EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 W PALMETTO ST
FLORENCE SC
29501-4425
US

IV. Provider business mailing address

436 W PALMETTO ST
FLORENCE SC
29501-4425
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-2007
  • Fax: 843-669-6677
Mailing address:
  • Phone: 843-669-2007
  • Fax: 843-669-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18276
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: