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NPI Code Detail

MEDICARE: DAVID EDWARD EVANS

MEDICARE: DAVID EDWARD EVANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2087578TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154800266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EDWARD EVANS
Provider Business Mailing Address
First Line : 19542 FM 2493
Second Line :
City : FLINT
State : TX
Zip : 75762-8832
Country : US
Telephone Number : 903-466-4634
Fax Number :
Provider Business Practice Location Address
First Line : 1401 RICE RD
Second Line :
City : TYLER
State : TX
Zip : 75703-3233
Country : US
Telephone Number : 903-561-6060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2018
Last Update Date : 08/09/2018

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Directions to “ DAVID EDWARD EVANS ” Practice Location

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