Provider Demographics
NPI:1124331475
Name:PERRY W EVANS JR DO PC
Entity type:Organization
Organization Name:PERRY W EVANS JR DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:918-358-2592
Mailing Address - Street 1:119 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-4614
Mailing Address - Country:US
Mailing Address - Phone:918-358-2592
Mailing Address - Fax:918-358-3133
Practice Address - Street 1:119 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4614
Practice Address - Country:US
Practice Address - Phone:918-358-2592
Practice Address - Fax:918-358-3133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY W EVANS JR DO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty