Basic Information
| Provider Information | |||||||||
| NPI: | 1629223607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN A EVANS, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8797 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049158797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103516500 | ||||||||
| FaxNumber: | 2103516509 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 NAVARRO ST | ||||||||
| Address2: | STE 1128 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782052516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103516500 | ||||||||
| FaxNumber: | 2103516509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2008 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | MADRID | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTICIONER | ||||||||
| AuthorizedOfficialTelephone: | 2103516500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 201668501 | 05 | TX | MEDICAID |