Healthcare Provider Details

I. General information

NPI: 1841491925
Provider Name (Legal Business Name): BRANDON EVANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

IV. Provider business mailing address

3336 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-3000
  • Fax: 479-463-3050
Mailing address:
  • Phone: 479-463-3000
  • Fax: 479-463-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberE-8032
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: