Provider Demographics
NPI:1508597667
Name:ZAVICAR, EVAN MATTHEW (PA-S2)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MATTHEW
Last Name:ZAVICAR
Suffix:
Gender:M
Credentials:PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 RESOURCE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6142
Mailing Address - Country:US
Mailing Address - Phone:814-818-5572
Mailing Address - Fax:281-481-8540
Practice Address - Street 1:11003 RESOURCE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6142
Practice Address - Country:US
Practice Address - Phone:281-481-8557
Practice Address - Fax:281-481-8540
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant