Provider Demographics
NPI:1164439469
Name:EVANS, SHERIDAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:SCOTT
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 1:5605 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5533
Mailing Address - Country:US
Mailing Address - Phone:972-548-5050
Mailing Address - Fax:972-548-6901
Practice Address - Street 1:5605 VIRGINIA PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5533
Practice Address - Country:US
Practice Address - Phone:972-548-5050
Practice Address - Fax:972-548-6901
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0007KAOtherBLUE CROSS BLUE SHIELD PR
TX0007KAOtherBLUE CROSS BLUE SHIELD PR
8A2511Medicare ID - Type Unspecified