Healthcare Provider Details

I. General information

NPI: 1720198880
Provider Name (Legal Business Name): ANTHONY C EVANS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST STE 515
BATON ROUGE LA
70817-5129
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-3006
  • Fax: 225-922-3743
Mailing address:
  • Phone: 225-216-3006
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number311933
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: