Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22583 | TX |
NPI | 1033293568 |
---|---|
Provider Name | Dr. Todd Larry Evans |
First Address | Belton, TX 76513-4741 |
Second Address | Temple, TX 76502-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 02/11/2010 |