Basic Information
| Provider Information | |||||||||
| NPI: | 1174678809 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRANK J EVANS, D.O. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1921 W 6TH AVE STE A | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055332433 | ||||||||
| FaxNumber: | 4055332434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1921 W 6TH AVE STE A | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740744204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055332433 | ||||||||
| FaxNumber: | 4055332434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4055332433 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3259 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100136900B | 05 | OK | MEDICAID |