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General NPI Number Information
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NPI Number | 1972693745
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Entity Type | Organization
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Legal Business Name | COLBY C EVANS PA
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9701 BRODIE LANE SUITE A-106
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City | AUSTIN
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State | TX
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Zip | 78748
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Country | US
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Telephone | 512-280-3939
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Fax | 512-280-3938
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Provider Business Mailing Address
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Address Line | 9901 BRODIE LN SUITE 160
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City | AUSTIN
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State | TX
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Zip | 78748-5803
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Country | US
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Telephone | 512-280-3939
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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. COLBY C EVANS
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Credential | M.D.
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Telephone | 512-280-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | L6879
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License Number State | TX
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