Provider Demographics
NPI:1588766810
Name:EVANS, COLBY CRAIG (MD)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:CRAIG
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9701 BRODIE LN
Mailing Address - Street 2:STE A-106
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:512-280-3939
Mailing Address - Fax:512-280-3938
Practice Address - Street 1:9701 BRODIE LANE
Practice Address - Street 2:SUITE A-106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-280-3939
Practice Address - Fax:512-280-3938
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6879207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4160Medicare ID - Type Unspecified
TXI65277Medicare UPIN
TXI65277Medicare UPIN