Provider Demographics
NPI:1790739746
Name:BATES, EVAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:S
Last Name:BATES
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 1:8230 WALNUT HILL LN
Mailing Address - Street 2:STE. 420
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-265-0800
Mailing Address - Fax:214-265-1027
Practice Address - Street 1:8230 WALNUT HILL LANE
Practice Address - Street 2:STE 420
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4400
Practice Address - Country:US
Practice Address - Phone:214-265-0800
Practice Address - Fax:214-265-1027
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4234288OtherAETNA PROVIDER NUMBER
TX040005350OtherMEDICARE RAILROAD PIN
TX88X321OtherBCBS PROVIDER NUMBER
TX4234288OtherAETNA PROVIDER NUMBER
TX88X321Medicare PIN
TX82Z540Medicare PIN