Provider Demographics
NPI:1750505152
Name:EVANGELISTA, PRISCO TINIO JR (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:PRISCO
Middle Name:TINIO
Last Name:EVANGELISTA
Suffix:JR
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:4331 MEADOWBANK DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4120
Mailing Address - Country:US
Mailing Address - Phone:281-474-5057
Mailing Address - Fax:281-474-7073
Practice Address - Street 1:4331 MEADOWBANK DR
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-4120
Practice Address - Country:US
Practice Address - Phone:281-474-5057
Practice Address - Fax:281-474-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXF7456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002578Medicaid
TX1002578Medicaid