Provider Demographics
NPI:1902220023
Name:BEVANS, ZACHARY DEAN (ATP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:DEAN
Last Name:BEVANS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4852
Mailing Address - Country:US
Mailing Address - Phone:817-338-4848
Mailing Address - Fax:817-338-4450
Practice Address - Street 1:100 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4852
Practice Address - Country:US
Practice Address - Phone:817-338-4848
Practice Address - Fax:817-338-4450
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75719247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other