Provider Demographics
NPI:1194999789
Name:OTO-HNS
Entity type:Organization
Organization Name:OTO-HNS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:EVASN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-420-7212
Mailing Address - Street 1:324 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3866
Mailing Address - Country:US
Mailing Address - Phone:972-420-7212
Mailing Address - Fax:972-420-8812
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-420-7212
Practice Address - Fax:972-420-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty