| Doctor Name: | JUSTIN COLIN EVERSON |
| NPI Number: | 1457604944 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MMS, PA-C |
| License Number: | C0004855 |
| Business Practice Address: | Building 19h, Room 270 Perry Point Va Medical Center Perry Point, MD - 21902 |
| Business Phone Number: | 4106422411 |
| Business Fax Number: | 4106421898 |
| Mailing Address: | Building 19h, Room 270, Perry Point Va Medical Center PERRY POINT |
| State: | MD |
| Postal Code: | 21902 |
| Phone Number: | 4106422411 |
| Fax Number: | 4106421898 |
| NPI Enumeration Date: | 10/21/2012 |
| NPI Last Update Date: | 06/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0004855 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |