Provider Demographics
NPI:1508058678
Name:EVERSOLE, GALEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:MARK
Last Name:EVERSOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 N PECOS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1349
Mailing Address - Country:US
Mailing Address - Phone:702-675-7100
Mailing Address - Fax:702-675-7101
Practice Address - Street 1:301 N PECOS RD
Practice Address - Street 2:SUITE E
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1349
Practice Address - Country:US
Practice Address - Phone:702-675-7100
Practice Address - Fax:702-675-7101
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2012-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO38786207ZP0102X
NM83-190207ZP0102X
NV12724207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology