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Individual
STANLEY EVANS
Active
Individual
STANLEY EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J1993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J74E
BCBS PROVIDER #
TX
05
—
092200701
—
TX
01
—
752696679
TAX ID #
TX
01
—
DOJ1993
WORKERS COMP PROVIDER ID
TX
Enumeration date
06/23/2005
Last updated
09/07/2021
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