Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD60067507 | WA |
Y | 2086S0120X | Pediatric Surgery | MD60067507 | WA |
NPI | 1437389962 |
---|---|
Provider Name | Mauricio A Escobar JR. |
First Address | Tacoma, WA 98405-3720 |
Second Address | Tacoma, WA 98405-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 06/12/2011 |