Basic Information
| Provider Information | |||||||||
| NPI: | 1649484155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | CODY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2651 NW THURMAN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972102326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039542403 | ||||||||
| FaxNumber: | 5039461156 | ||||||||
| Practice Location | |||||||||
| Address1: | 2651 NW THURMAN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972102326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039542403 | ||||||||
| FaxNumber: | 5039461156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MD28394 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | MD28394 | OR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.