Provider Demographics
NPI:1699096354
Name:HARDEGREE, EVAN LOWELL (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:LOWELL
Last Name:HARDEGREE
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 1:1201 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2932
Mailing Address - Country:US
Mailing Address - Phone:325-793-3100
Mailing Address - Fax:325-793-3195
Practice Address - Street 1:1201 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2932
Practice Address - Country:US
Practice Address - Phone:325-793-3100
Practice Address - Fax:325-793-3195
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54127207R00000X
TXP5986207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIENROLLEDMedicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MNP01034529OtherRAILROAD MEDICARE
WIENROLLEDMedicaid