Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 01044143A | IN |
Y | 207SG0201X | Clinical Genetics (M.D.) | 01044143A | IN |
N | 208000000X | Pediatrician | 01044143A | IN |
N | 2080N0001X | Neonatal-Perinatal Doctor | 01044143A | IN |
NPI | 1053396135 |
---|---|
Provider Name | Luis Fernando Escobar |
First Address | Indianapolis, IN 46260-1316 |
Second Address | Indianapolis, IN 46260-2052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2005 |
Last Update Date | 28/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200182960 | (05) | IN |
H10379 | (02) |