MEDICARE: GARY D EVANS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	1-034588	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00348467	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51003654	OTHER	AL	BC BS OF AL #
2	1326043944	OTHER	AL	TRICARE STANDARD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326043944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY D EVANS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 55905
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35255-5905
Country	:	US
Telephone Number	:	205-979-5882
Fax Number	:	205-979-1248

Provider Business Practice Location Address
First Line	:	1201 11TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3423
Country	:	US
Telephone Number	:	205-930-7296
Fax Number	:	205-930-7256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/02/2010

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Directions to “ GARY D EVANS CRNA” Practice Location

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