Evans, Jack L

Evans, Jack L is an sole proprietor health care provider with primary practice located at 629 N Sandusky Ave , Bucyrus OH 44820-1821. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Evans, Jack L can be contacted via phone (419) 562-4677.

Contact Information

Primary practice address
629 N Sandusky Ave Bucyrus OH 44820-1821
Phone: (419) 562-4677
Fax: (419) 562-0987
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 35044381 Ohio

Profile Details

NPI number 1033175781
LBN Legal business name Evans, Jack L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 21st, 2006
Last updated Dec 27th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033175781 NPPES
Ohio Other 000000382640 BCBS
Ohio Other POO328458 BCBS
Ohio MEDICAID 0464180 BCBS
Ohio Other 000000316691 BCBS

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