Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 2015019922 | MO |
NPI | 1043214760 |
---|---|
Provider Name | Dr. Susana Escalante-Glorsky |
First Address | St Louis, MO 63150 |
Second Address | Mcallen, TX 78504-6113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 07/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E68888 | (02) | TX |