Provider Demographics
NPI:1558518241
Name:BAYSHORE FAMILY PRACTITIONERS PLLC
Entity Type:Organization
Organization Name:BAYSHORE FAMILY PRACTITIONERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-852-1500
Mailing Address - Street 1:2231 CENTER ST
Mailing Address - Street 2:STE D
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4186
Mailing Address - Country:US
Mailing Address - Phone:281-479-3670
Mailing Address - Fax:866-457-4168
Practice Address - Street 1:2231 CENTER ST
Practice Address - Street 2:STE. D
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4186
Practice Address - Country:US
Practice Address - Phone:281-479-3670
Practice Address - Fax:866-457-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201928301Medicaid
TX00Z823Medicare PIN
TX201928301Medicaid