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General NPI Number Information
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NPI Number | 1487972220
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Entity Type | Organization
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Legal Business Name | JASON EVAN MD PA
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 3101 S 77 SUNSHINE STRIP #A
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City | HARLINGEN
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State | TX
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Zip | 78550-8904
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Country | US
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Telephone | 956-778-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 S 77 SUNSHINE STRIP #A
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City | HARLINGEN
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State | TX
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Zip | 78550-8904
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Country | US
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Telephone | 956-778-4486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON EVANS
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Credential | MD
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Telephone | 956-778-4486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | M9268
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License Number State | TX
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