Provider Demographics
NPI:1720254972
Name:EVICK, JAMIE (DO)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:EVICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:ETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-234-8885
Mailing Address - Fax:
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-234-8885
Practice Address - Fax:304-234-1838
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012233207R00000X
WV2198207R00000X
PAOS014252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2198OtherSTATE LICENSE NUMBER
OH34.012233OtherSTATE LICENSE NUMBER
PAOS014252OtherSTATE LICENSE NUMBER