Provider Demographics
NPI:1689637290
Name:EVANS, RICHARD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
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 1:171 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5410
Mailing Address - Country:US
Mailing Address - Phone:336-625-2456
Mailing Address - Fax:336-625-1136
Practice Address - Street 1:171 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5410
Practice Address - Country:US
Practice Address - Phone:336-625-2456
Practice Address - Fax:336-625-1136
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101197208600000X
TNMD0000030619208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
17-00204OtherUHC
NC891292AMedicaid
NC1292AOtherBC/BS
G82258Medicare UPIN
NC891292AMedicaid