Healthcare Provider Details

I. General information

NPI: 1194056382
Provider Name (Legal Business Name): THADEUS J EVANS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10039 BISSONNET ST STE 250
HOUSTON TX
77036-7852
US

IV. Provider business mailing address

10039 BISSONNET ST STE 250
HOUSTON TX
77036-7852
US

V. Phone/Fax

Practice location:
  • Phone: 713-779-9800
  • Fax: 713-779-9813
Mailing address:
  • Phone: 713-779-9800
  • Fax: 713-779-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number133523
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: