Provider Demographics
NPI:1093007437
Name:EVANS, JEROME (AUD)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 MEDICAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4983
Mailing Address - Country:US
Mailing Address - Phone:210-474-6766
Mailing Address - Fax:210-568-6164
Practice Address - Street 1:5282 MEDICAL DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4983
Practice Address - Country:US
Practice Address - Phone:210-474-6766
Practice Address - Fax:210-568-6164
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80325231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist