Provider Demographics
NPI:1558318535
Name:EVANS, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
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 1:927 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5203
Mailing Address - Country:US
Mailing Address - Phone:704-377-5772
Mailing Address - Fax:704-377-3389
Practice Address - Street 1:720 MALCOLM BLVD
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-2872
Practice Address - Country:US
Practice Address - Phone:828-580-7620
Practice Address - Fax:704-377-3389
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00819208VP0014X
SC27534208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906671Medicaid
NCP01011051OtherRAILROAD-MEDICARE
NC147K8OtherBCBS
SC275348Medicaid
NC147K8OtherBCBS
SCAA0821A309Medicare PIN
SC275348Medicaid