Provider Demographics
NPI:1962692111
Name:EAVENSON, FRANCISCO XAVIER (IDC)
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:XAVIER
Last Name:EAVENSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 GAINESVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:STENNIS SPACE CENTER
Mailing Address - State:MS
Mailing Address - Zip Code:39529-0001
Mailing Address - Country:US
Mailing Address - Phone:228-813-4000
Mailing Address - Fax:228-813-4021
Practice Address - Street 1:2603 GAINESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:STENNIS SPACE CENTER
Practice Address - State:MS
Practice Address - Zip Code:39529-0001
Practice Address - Country:US
Practice Address - Phone:228-813-4000
Practice Address - Fax:228-813-4021
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman