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General NPI Number Information
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NPI Number | 1811037716
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Entity Type | Individual
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Provider Name | EVAN CHISUM MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 4001 J ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3626
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Country | US
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Telephone | 330-493-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 150 CASHMAN CIR
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City | SACRAMENTO
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State | CA
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Zip | 95835-1606
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Country | US
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Telephone | 916-419-8841
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A78813
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License Number State | CA
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