Provider Demographics
NPI:1417215344
Name:LONGFIELD, EVAN ANDREW
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:ANDREW
Last Name:LONGFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5469
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-371-7090
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY STE 205
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1996
Practice Address - Country:US
Practice Address - Phone:254-618-1095
Practice Address - Fax:254-618-1101
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3553207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology