Provider Demographics
NPI:1093733073
Name:EVANS, JOHN WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAMS
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6437
Mailing Address - Country:US
Mailing Address - Phone:707-933-9757
Mailing Address - Fax:707-939-0688
Practice Address - Street 1:670 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6437
Practice Address - Country:US
Practice Address - Phone:707-933-9757
Practice Address - Fax:707-939-0688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA238642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23734Medicare UPIN
CA00A238640Medicare ID - Type Unspecified