Provider Demographics
NPI:1649484155
Name:EVANS, CODY J (MD)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2651 NW THURMAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2326
Mailing Address - Country:US
Mailing Address - Phone:503-954-2403
Mailing Address - Fax:503-946-1156
Practice Address - Street 1:2651 NW THURMAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2326
Practice Address - Country:US
Practice Address - Phone:503-954-2403
Practice Address - Fax:503-946-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD283942084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry