Provider Demographics
NPI:1407897952
Name:EVANS, M. BRADLEY (MD PA)
Entity Type:Individual
Prefix:
First Name:M.
Middle Name:BRADLEY
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:BRADLEY
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PA
Mailing Address - Street 1:324 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3866
Practice Address - Country:US
Practice Address - Phone:972-420-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3218207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3218OtherMEDICAL LICENSE
TXM3218OtherMEDICAL LICENSE