Provider Demographics
NPI:1619913761
Name:EVANS, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3631 BIENVILLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5702
Mailing Address - Country:US
Mailing Address - Phone:228-818-9620
Mailing Address - Fax:228-818-9750
Practice Address - Street 1:3631 BIENVILLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5702
Practice Address - Country:US
Practice Address - Phone:228-818-9620
Practice Address - Fax:228-818-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS188742084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00389398OtherRAILROAD MEDICARE
MS01257147Medicaid
646000515OtherDEPARTMENT OF LABOR
646000515OtherCOMMERCIAL
MS01257147Medicaid
P00389398OtherRAILROAD MEDICARE
13000350Medicare UPIN
$$$$$$$$$OtherTRICARE
646000515OtherDEPARTMENT OF LABOR