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General NPI Number Information
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NPI Number | 1437679651
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Entity Type | Individual
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Provider Name | EVAN BRANSCUM MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 1401 HWY 65 NORTH SUITE 200
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City | HARRISON
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State | AR
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Zip | 72601-2737
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Country | US
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Telephone | 870-743-9744
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Fax | 870-743-9746
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Provider Business Mailing Address
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Address Line | PO BOX 802843
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City | KANSAS CITY
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State | MO
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Zip | 64180-2843
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Country | US
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Telephone | 417-730-6430
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Fax | 417-269-7567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2018023700
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-13273
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License Number State | AR
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