Provider Demographics
NPI:1568482255
Name:EVANS, RICKY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:490-212-1000
Mailing Address - Fax:409-813-3302
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:490-212-1000
Practice Address - Fax:409-813-3302
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ3872207V00000X
NC9600266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911537Medicaid
TX346009902Medicaid
TX346009902Medicaid
TX346009902Medicaid