MEDICARE: DONNIE EVANS MD PA

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
1	202C00000X	Independent Medical Examiner Physician	H5705	TX
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	H5705	TX

General Provider Information

NPI Number	:	1205271327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNIE EVANS MD PA

Provider Business Mailing Address
First Line	:	4315 LOCKWOOD DR STE 4
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-4060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 HORSESHOE DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3416
Country	:	US
Telephone Number	:	281-242-4104
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. DONNIE EVANS
Credential	:	MD
Telephone Number	:	281-451-4654

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	01/09/2014

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