Individual
DR. LARRY W EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6202 IOLA AVE STE 101, LUBBOCK, TX 79424-2729
(806) 799-2093
(806) 783-0277
Mailing address
6202 IOLA AVE STE 101, LUBBOCK, TX 79424-2729
(806) 799-2093
(806) 783-0277
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
H6203
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
H6203
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134049911
—
TX
01
—
152248403
EPSDT
TX
01
—
5683525
AETNA
TX
01
—
752616977065
TRICARE CHAMPUS
TX
01
—
EV08J0375
BCBS
TX
01
—
P00253558
MEDICARE RAILROAD
TX
Enumeration date
02/13/2006
Last updated
04/30/2015
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