Healthcare Provider Details

I. General information

NPI: 1417064478
Provider Name (Legal Business Name): OLAN EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST SUITE 804
MONTGOMERY AL
36106-1103
US

IV. Provider business mailing address

1722 PINE ST SUITE 804
MONTGOMERY AL
36106-1103
US

V. Phone/Fax

Practice location:
  • Phone: 334-834-7221
  • Fax: 334-241-9848
Mailing address:
  • Phone: 334-834-7221
  • Fax: 334-241-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number00015591
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: