MEDICARE: DONNIE EVANS MDPA

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	101Y00000X	Counselor	H5705	TX
2	363L00000X	Nurse Practitioner	H5705	TX
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	H5705	TX

General Provider Information

NPI Number	:	1508146465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNIE EVANS MDPA

Provider Business Mailing Address
First Line	:	1310 HORSESHOE DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3416
Country	:	US
Telephone Number	:	281-451-3267
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	:	281-451-3267
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONNIE EVANS
Credential	:	MD
Telephone Number	:	281-451-3267

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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