Individual
DR. JOHN DAVID EVANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5000 LONG PRAIRIE RD, FLOWER MOUND, TX 75028
(972) 420-1776
(972) 436-6996
Mailing address
5000 LONG PRAIRIE RD, FLOWER MOUND, TX 75028-2783
(972) 420-1776
(972) 436-6996
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
L2878
TX
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
L2878
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145018102
—
TX
01
—
200042050
RAILROAD MEDICARE
TX
01
—
8AJ226
BLUECROSS
TX
01
—
L2878
MEDICAL LICENSE
TX
Enumeration date
05/05/2006
Last updated
07/26/2018
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