Provider Demographics
NPI:1659391464
Name:EVANS, CRAIG RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RANDALL
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:#140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-755-1515
Mailing Address - Fax:405-936-5211
Practice Address - Street 1:1208 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3001
Practice Address - Country:US
Practice Address - Phone:405-340-2100
Practice Address - Fax:405-340-1184
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255260BMedicaid
OK100255260BMedicaid