Healthcare Provider Details

I. General information

NPI: 1659344042
Provider Name (Legal Business Name): GENE H EVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 6TH ST
PAWNEE OK
74058-2542
US

IV. Provider business mailing address

PO BOX 387
PAWNEE OK
74058-0387
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-3942
  • Fax: 918-762-4675
Mailing address:
  • Phone: 918-762-3942
  • Fax: 918-762-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21798
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: