Provider Demographics
NPI:1629223607
Name:JOHN A EVANS, MD, PA
Entity type:Organization
Organization Name:JOHN A EVANS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTICIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:210-351-6500
Mailing Address - Street 1:PO BOX 8797
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8797
Mailing Address - Country:US
Mailing Address - Phone:210-351-6500
Mailing Address - Fax:210-351-6509
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:STE 1128
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-351-6500
Practice Address - Fax:210-351-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201668501Medicaid
TX0A0234Medicare PIN