Provider Demographics
NPI:1922004175
Name:EVANS, CARL R (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:R
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:476 SUMMIT CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5032
Mailing Address - Country:US
Mailing Address - Phone:830-990-4378
Mailing Address - Fax:830-997-0856
Practice Address - Street 1:1006 HWY 16 S
Practice Address - Street 2:STE G
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4474
Practice Address - Country:US
Practice Address - Phone:830-997-1317
Practice Address - Fax:830-997-0856
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG2957207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134411101Medicaid
E14637Medicare UPIN
TX83P510Medicare PIN