Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E5747 | TX |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | E5747 | TX |
NPI | 1063510493 |
---|---|
Provider Name | Dr. Marco R Escobar |
First Address | Bellaire, TX 77401-3957 |
Second Address | Bellaire, TX 77401-3957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 12/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111948905 | (05) | TX |
8A1260 | BCBS (01) | TX |
B22571 | (02) | TX |