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General NPI Number Information
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NPI Number | 1407449192
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Entity Type | Individual
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Provider Name | JAKE ALAN EVERETT MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2021
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 590 MEDICAL CENTER ROAD
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone | 254-553-2630
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Fax |
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Provider Business Mailing Address
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Address Line | 590 MEDICAL CENTER ROAD
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City | FORT CAVAZOS
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State | TX
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Zip | 76544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | U0583
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | U0583
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License Number State | TX
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