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General NPI Number Information
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NPI Number | 1720237845
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Entity Type | Individual
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Provider Name | GARETH JAMES EVANS
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Gender | Male
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 4389 BEAUFORT RD.
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City | CHERRY POINT
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State | NC
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Zip | 28533
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Country | US
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Telephone | 858-220-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 487 MADISON DR 118
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City | HAVELOCK
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State | NC
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Zip | 28532-3603
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Country | US
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Telephone | 858-220-0918
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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