Provider Demographics
NPI:1033177977
Name:EVANS, ROGER WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIAMS
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2182
Mailing Address - Country:US
Mailing Address - Phone:316-858-9000
Mailing Address - Fax:316-858-9005
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-858-9000
Practice Address - Fax:316-858-9005
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-13261207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100133670FMedicaid
060036462OtherRAILROAD MEDICARE
OK100206090BMedicaid
KS100133670FMedicaid
OK$$$$$$$$$Medicare PIN
KS060596Medicare PIN