Individual
MARK A EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
417 N MAIN, GRAINTE, OK 73547
(580) 872-4362
(877) 785-6691
Mailing address
PO BOX 476, GRANITE, OK 73547
(580) 872-4362
(877) 785-6691
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OK802
OK
363A00000X
Physician Assistant
802
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100054690A
—
OK
05
—
100699750C
—
OK
Enumeration date
09/29/2006
Last updated
08/22/2024
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