MEDICARE: DR. WILLIAM J EVANS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	18874	MS
2	2084N0400X	Neurology Physician	18874	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00389398	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	646000515	OTHER	DEPARTMENT OF LABOR
4	646000515	OTHER	COMMERCIAL

General Provider Information

NPI Number	:	1619913761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J EVANS MD

Provider Business Mailing Address
First Line	:	3631 BIENVILLE BLVD
Second Line	:	SUITE A
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5702
Country	:	US
Telephone Number	:	228-818-9620
Fax Number	:	228-818-9750

Provider Business Practice Location Address
First Line	:	3631 BIENVILLE BLVD
Second Line	:	SUITE A
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5702
Country	:	US
Telephone Number	:	228-818-9620
Fax Number	:	228-818-9750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/02/2022

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Directions to “ DR. WILLIAM J EVANS MD” Practice Location

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