Provider Demographics
NPI:1497441331
Name:THOMSON, EVAN CHAURETTE (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:CHAURETTE
Last Name:THOMSON
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 1:910 MADISON AVE STE 428
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3403
Mailing Address - Country:US
Mailing Address - Phone:901-448-5885
Mailing Address - Fax:901-448-5120
Practice Address - Street 1:920 MADISON AVENUE SUITE 447
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2726
Practice Address - Country:US
Practice Address - Phone:901-448-5885
Practice Address - Fax:901-448-5120
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program