Provider Demographics
NPI:1588818413
Name:VON L. EVANS JR., M.D., P.A.
Entity Type:Organization
Organization Name:VON L. EVANS JR., M.D., P.A.
Other - Org Name:TARRANT COUNTY BONE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:A/R SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-926-2663
Mailing Address - Street 1:PO BOX 6426
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0426
Mailing Address - Country:US
Mailing Address - Phone:817-926-2663
Mailing Address - Fax:817-546-3945
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:STE. 346
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-926-2663
Practice Address - Fax:817-546-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133191004Medicaid
TXH3877OtherLICENSE
TX133191004Medicaid