Provider Demographics
NPI:1841616679
Name:WARD, EVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 GEMINI ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2806
Mailing Address - Country:US
Mailing Address - Phone:281-335-1111
Mailing Address - Fax:281-286-9250
Practice Address - Street 1:1045 GEMINI ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2806
Practice Address - Country:US
Practice Address - Phone:281-335-1111
Practice Address - Fax:281-286-9250
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant