Healthcare Provider Details

I. General information

NPI: 1689637290
Provider Name (Legal Business Name): RICHARD ALAN EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MACARTHUR ST
ASHEBORO NC
27203-5410
US

IV. Provider business mailing address

171 MACARTHUR ST
ASHEBORO NC
27203-5410
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-2456
  • Fax: 336-625-1136
Mailing address:
  • Phone: 336-625-2456
  • Fax: 336-625-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200101197
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000030619
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: