Provider Demographics
NPI:1558310672
Name:EVANS, BRYAN DEAN (MD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DEAN
Last Name:EVANS
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 1:2089 CECIL ASHBURN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802
Mailing Address - Country:US
Mailing Address - Phone:256-882-5060
Mailing Address - Fax:256-882-9990
Practice Address - Street 1:2089 CECIL ASHBURN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802
Practice Address - Country:US
Practice Address - Phone:256-882-6487
Practice Address - Fax:256-429-9383
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
51038144OtherBCBS
E37235Medicare UPIN
000038144Medicare ID - Type Unspecified