Provider Demographics
NPI:1922045327
Name:PIVALIZZA, EVAN G (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:G
Last Name:PIVALIZZA
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6200
Practice Address - Fax:713-500-6264
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3826207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132243006Medicaid
TX8X6131OtherBCBS
TX83Z520OtherBCBS
TX132243008Medicaid
TX132243001OtherCSHCN
TX83Z520Medicare PIN
TX8X6131OtherBCBS
TX132243001OtherCSHCN
TX050060421Medicare PIN