MEDICARE: PAUL DOUGLAS EVANS MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0202X	Diagnostic Radiology Physician	P9560	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1215181177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DOUGLAS EVANS MD

Provider Business Mailing Address
First Line	:	800 PEAKWOOD DR STE 5E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2903
Country	:	US
Telephone Number	:	281-440-5158
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PEAKWOOD DR STE 5E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-2903
Country	:	US
Telephone Number	:	281-440-5158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/30/2017

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