Provider Demographics
NPI:1376087197
Name:EVOKE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:EVOKE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-401-1699
Mailing Address - Street 1:391 LAS COLINAS BLVD E
Mailing Address - Street 2:SUITE 130504
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-6291
Mailing Address - Country:US
Mailing Address - Phone:817-696-7595
Mailing Address - Fax:972-499-9185
Practice Address - Street 1:1104 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5175
Practice Address - Country:US
Practice Address - Phone:469-361-1234
Practice Address - Fax:972-449-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129266204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty