Basic Information
| Provider Information | |||||||||
| NPI: | 1366400632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6725 SW 29TH ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666145625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854781500 | ||||||||
| FaxNumber: | 7854781508 | ||||||||
| Practice Location | |||||||||
| Address1: | 6725 SW 29TH ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666145625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854781500 | ||||||||
| FaxNumber: | 7854781508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-27436 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100338230A | 05 | KS | MEDICAID |