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General NPI Number Information
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NPI Number | 1124331475
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Entity Type | Organization
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Legal Business Name | PERRY W EVANS JR DO PC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 119 S BROADWAY ST
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City | CLEVELAND
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State | OK
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Zip | 74020-4614
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Country | US
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Telephone | 918-358-2592
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Fax | 918-358-3133
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Provider Business Mailing Address
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Address Line | 119 S BROADWAY ST
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City | CLEVELAND
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State | OK
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Zip | 74020-4614
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Country | US
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Telephone | 918-358-2592
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Fax | 918-358-3133
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Authorized Official
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Title or Position | OWNER
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Name | DR. PERRY WILLIAM EVANS JR.
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Credential | DO
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Telephone | 918-358-2592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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