Provider Demographics
NPI:1477549012
Name:EVANS, PAUL J (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:5 BUCKNAM RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1392
Practice Address - Country:US
Practice Address - Phone:207-781-1551
Practice Address - Fax:207-781-1522
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEPA588363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00985681Medicare PIN
MEAP084802Medicare PIN
MES31634Medicare UPIN
MEAP084801Medicare PIN