Provider Demographics
NPI:1861429862
Name:EVANS, PATRICIA W (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:W
Last Name:EVANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SAGE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2324
Mailing Address - Country:US
Mailing Address - Phone:832-298-6618
Mailing Address - Fax:
Practice Address - Street 1:513 SAGE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2324
Practice Address - Country:US
Practice Address - Phone:832-298-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7925208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170807502OtherCSHCN
TX8P2603OtherBCBS
TX170807501Medicaid
TX170807502OtherCSHCN
TX8D1539Medicare PIN