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General NPI Number Information
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NPI Number | 1740234251
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Entity Type | Individual
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Provider Name | JAYSON LEE EVERSGERD D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 1028 FORUM DR
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City | BROUSSARD
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State | LA
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Zip | 70518-8060
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Country | US
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Telephone | 774-284-0496
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GRAND ST
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City | NEW BRITAIN
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State | CT
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Zip | 06052-2016
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Country | US
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Telephone | 860-224-5675
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Fax | 860-224-5774
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 044170
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License Number State | CT
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