Provider Demographics
NPI:1780684076
Name:EVANS, RANDOLPH WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:WARREN
Last Name:EVANS
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 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6933
Mailing Address - Country:US
Mailing Address - Phone:713-528-0725
Mailing Address - Fax:713-528-3628
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 1370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6933
Practice Address - Country:US
Practice Address - Phone:713-528-0725
Practice Address - Fax:713-528-3628
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF15332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036230301Medicaid
TX036230301Medicaid
C15535Medicare UPIN