Provider Demographics
NPI:1659344042
Name:EVANS, GENE H (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:H
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 387
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-0387
Mailing Address - Country:US
Mailing Address - Phone:918-762-3942
Mailing Address - Fax:918-762-4675
Practice Address - Street 1:535 6TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2542
Practice Address - Country:US
Practice Address - Phone:918-762-3942
Practice Address - Fax:918-762-4675
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100153150AMedicaid
OK100153150AMedicaid
OKF92420Medicare UPIN