Provider Demographics
NPI:1437679651
Name:BRANSCUM, EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:BRANSCUM
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:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1401 HWY 65 NORTH SUITE 200
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2737
Practice Address - Country:US
Practice Address - Phone:870-743-9744
Practice Address - Fax:870-743-9746
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018023700207Q00000X
ARE-13273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine