Provider Demographics
NPI:1154883023
Name:EVANS, BRIAN THOMAS (RDMS)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:THOMAS
Last Name:EVANS
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 N GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-8025
Mailing Address - Country:US
Mailing Address - Phone:559-901-3488
Mailing Address - Fax:559-384-3175
Practice Address - Street 1:1070 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274
Practice Address - Country:US
Practice Address - Phone:559-901-3488
Practice Address - Fax:559-384-3175
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1703212085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
170321OtherADRMS