Provider Demographics
NPI:1801843115
Name:EVANS, KURT J
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-2450
Mailing Address - Fax:
Practice Address - Street 1:1050 W ARKANSAS LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6308
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-702-4801
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2120208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01488718OtherRAILROAD MEDICARE
TX8ER621OtherBCBS
TX116143204Medicaid
TX372584YL1ZMedicare PIN
TX752619345Medicare UPIN
TX116143204Medicaid