Provider Demographics
NPI:1295724284
Name:EVANS, JAMES ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:310 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6008
Mailing Address - Country:US
Mailing Address - Phone:423-929-7393
Mailing Address - Fax:423-929-0872
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6008
Practice Address - Country:US
Practice Address - Phone:423-929-7393
Practice Address - Fax:423-929-0872
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2017-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN179302086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006764Medicaid
TN3052015Medicaid
TN3052017Medicare PIN
TN3052015Medicaid
TN3709218Medicare PIN