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General NPI Number Information
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NPI Number | 1962666420
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Entity Type | Individual
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Provider Name | CORY ROBERT EVANS MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 877 JEFFERSON AVE
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City | MEMPHIS
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State | TN
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Zip | 38103-2807
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Country | US
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Telephone | 901-545-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 910 MADISON AVE 2ND FLOOR
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City | MEMPHIS
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State | TN
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Zip | 38103-3403
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Country | US
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Telephone | 901-448-8140
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD000051039
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 51039
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License Number State | TN
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