Provider Demographics
NPI:1649212838
Name:SHRAGO, EVAN LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:LOUIS
Last Name:SHRAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 794948
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-4948
Mailing Address - Country:US
Mailing Address - Phone:972-488-8926
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:972-488-8926
Practice Address - Fax:972-881-4390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6928207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8704B0Medicare PIN
TX8703B0Medicare PIN