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Individual

DR. EVAN M EVANS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H6201
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000527435
BS KY PROVIDER #
KY
05
103066004
TX
05
103066008
TX
05
103066009
TX
05
7100015000
KY
01
750818167013
TRICARE MFH/ROSS BREAST CENTER
TX
01
752616977007
TRICARE TRINITY CLINIC
TX
01
752616977113
TRICARE
TX
01
8B0529
BCBS MFH/ROSS BREAST CENTER
TX
01
8CU198
BCBS MFH-JV-RBC LOCATION
TX
01
8M8275
BCBS TRINITY CLINIC
TX
01
TIN PLUS 005
TRICARE MFH-JV-RBC LOCATION
TX
Enumeration date
02/13/2006
Last updated
06/19/2023
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