Provider Demographics
NPI:1760463129
Name:EVANS, MITCHELL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:D
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:116 N SADDLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7718
Mailing Address - Country:US
Mailing Address - Phone:512-789-4466
Mailing Address - Fax:512-329-6898
Practice Address - Street 1:116 N SADDLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7718
Practice Address - Country:US
Practice Address - Phone:512-789-4466
Practice Address - Fax:512-329-6898
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2365207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117304902Medicaid
TX81G292OtherBC/BS
TX117304902Medicaid
E79424Medicare UPIN