Provider Demographics
NPI:1568578789
Name:EVANS, DONNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNIE
Middle Name:
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:PO BOX 2455
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2455
Mailing Address - Country:US
Mailing Address - Phone:281-451-4564
Mailing Address - Fax:
Practice Address - Street 1:18131 OBELISK BAY DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5628
Practice Address - Country:US
Practice Address - Phone:281-451-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143123OtherGROUP PTAN
TXTXB143124OtherINDIVIDUAL PTAN
TXBE2967391OtherDEA
TXTXB143124OtherINDIVIDUAL PTAN