Healthcare Provider Details

I. General information

NPI: 1265441513
Provider Name (Legal Business Name): EVELYN ARCHER MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S COULTER ST UNIT B
AMARILLO TX
79106-1784
US

IV. Provider business mailing address

PO BOX 8337
AMARILLO TX
79114-8337
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-8395
  • Fax:
Mailing address:
  • Phone: 806-355-6593
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH0139
License Number StateTX

VIII. Authorized Official

Name: DR. EVELYN ARCHER
Title or Position: OWNER
Credential: MD
Phone: 806-358-8392