Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01039089 | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01039089 | IN |
N | 207QA0505X | Family Doctor - Adult Medicine | 01039089 | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 01039089 | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | 01039089 | IN |
NPI | 1215937404 |
---|---|
Provider Name | Dr. Paul R Esguerra |
First Address | Linton, IN 47441-9407 |
Second Address | Linton, IN 47441-9407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 24/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000089459 | BC/BS # (01) | IN |
100125020 | (05) | IN |
E15882 | (02) | IN |