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General NPI Number Information
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NPI Number | 1750505152
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Entity Type | Individual
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Provider Name | PRISCO TINIO EVANGELISTA JR. M.D., F.A.C.S.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4331 MEADOWBANK DR
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City | SEABROOK
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State | TX
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Zip | 77586-4120
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Country | US
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Telephone | 281-474-5057
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Fax | 281-474-7073
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Provider Business Mailing Address
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Address Line | 4331 MEADOWBANK DR
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City | SEABROOK
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State | TX
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Zip | 77586-4120
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Country | US
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Telephone | 281-474-5057
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Fax | 281-474-7073
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | F7456
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License Number State | TX
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