MEDICARE: JASON EVAN 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	103TC0700X	Clinical Psychologist	M9268	TX

General Provider Information

NPI Number	:	1487972220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON EVAN MD PA

Provider Business Mailing Address
First Line	:	3101 S 77 SUNSHINE STRIP #A
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8904
Country	:	US
Telephone Number	:	956-778-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 S 77 SUNSHINE STRIP #A
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8904
Country	:	US
Telephone Number	:	956-778-4486
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASON EVANS
Credential	:	MD
Telephone Number	:	956-778-4486

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	07/20/2010

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