Individual
DR. LAUREN DEEANN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(173) 210-4048
(469) 458-9900
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
BP10040572
TX
2085R0204X
Vascular & Interventional Radiology Physician
Primary
Q2545
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841583796
—
TX
Enumeration date
05/25/2011
Last updated
08/10/2022
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