Provider Demographics
NPI:1417064478
Name:EVANS, OLAN (MD)
Entity type:Individual
Prefix:DR
First Name:OLAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PINE ST
Mailing Address - Street 2:SUITE 804
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:334-834-7221
Mailing Address - Fax:334-241-9848
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:SUITE 804
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-834-7221
Practice Address - Fax:334-241-9848
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015591207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC36744OtherSENIORS FIRST
ALGEHAOther630755234
AL00004340709OtherAETNA
AL630755234OtherUNITED HEALTHCARE
AL630755234OtherHUMANA
AL630755234OtherBIG LOTS
AL630755234OtherWAUSAU
AL000082998Medicaid
AL630755234OtherCIGNA
AL630755234OtherPACIFICARE
AL630755234OtherGREAT WEST
AL040017480OtherRAILROAD MEDICARE
AL51082998OtherBCBS
AL630755234OtherASSURANT
AL630755234OtherGREAT WEST
AL630755234OtherHUMANA