Provider Demographics
NPI:1285652735
Name:EVANS, JAMES T (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2653
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-2653
Mailing Address - Country:US
Mailing Address - Phone:843-706-7090
Mailing Address - Fax:716-898-5029
Practice Address - Street 1:29 PLANTATION PARK DR BLDG 600
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9001
Practice Address - Country:US
Practice Address - Phone:843-706-7090
Practice Address - Fax:843-706-7078
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105969208600000X
SCVL205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00604655Medicaid
C49554Medicare UPIN
NY00604655Medicaid