Provider Demographics
NPI:1841271749
Name:EVANS, ROBERT D (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:EVANS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 N LEE AVE
Mailing Address - Street 2:STE 236
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2600
Mailing Address - Country:US
Mailing Address - Phone:660-826-5960
Mailing Address - Fax:660-826-4852
Practice Address - Street 1:1111 N LEE AVE
Practice Address - Street 2:SUITE 236
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2620
Practice Address - Country:US
Practice Address - Phone:405-524-4105
Practice Address - Fax:405-235-0738
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-02-17
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Provider Licenses
StateLicense IDTaxonomies
OK17824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK050035141OtherRR MEDICARE
OK100029470AMedicaid
OKF17679Medicare UPIN