Provider Demographics
NPI:1205148459
Name:UNDERWOOD, EVAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:LEE
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SMITH COUNTY ROAD 40
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119
Mailing Address - Country:US
Mailing Address - Phone:601-517-6019
Mailing Address - Fax:
Practice Address - Street 1:420 SMITH COUNTY ROAD 40
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119
Practice Address - Country:US
Practice Address - Phone:601-517-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23099207P00000X
TXP8742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine