Provider Demographics
NPI:1760889943
Name:EVANS, ALAN THOMAS (PA)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:THOMAS
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 PILGRIM JOURNEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6860
Mailing Address - Country:US
Mailing Address - Phone:281-650-6225
Mailing Address - Fax:
Practice Address - Street 1:1830 PILGRIM JOURNEY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-6860
Practice Address - Country:US
Practice Address - Phone:281-650-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant