Provider Demographics
NPI:1932162245
Name:EVANS, HENRY M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:M
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4301 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3875
Mailing Address - Country:US
Mailing Address - Phone:504-284-3866
Mailing Address - Fax:504-284-3869
Practice Address - Street 1:4301 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3875
Practice Address - Country:US
Practice Address - Phone:504-284-3866
Practice Address - Fax:504-284-3869
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1133582Medicaid
LA5L889Medicare ID - Type Unspecified
LAC67262Medicare UPIN