Provider Demographics
NPI:1770557373
Name:EVANS, LARRY W (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:EVANS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6202 IOLA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2729
Mailing Address - Country:US
Mailing Address - Phone:806-799-2093
Mailing Address - Fax:806-783-0277
Practice Address - Street 1:6202 IOLA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2729
Practice Address - Country:US
Practice Address - Phone:806-799-2093
Practice Address - Fax:806-783-0277
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6203207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134049911Medicaid
TX752616977065OtherTRICARE CHAMPUS
TXP00253558OtherMEDICARE RAILROAD
TX152248403OtherEPSDT
TX5683525OtherAETNA
TXEV08J0375OtherBCBS
TXEV08J0375OtherBCBS
TXP00253558OtherMEDICARE RAILROAD