MEDICARE: GINA Y ESCOBAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD4347	AK

General Provider Information

NPI Number	:	1962560268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA Y ESCOBAR MD

Provider Business Mailing Address
First Line	:	3875 GEIST RD
Second Line	:	SUITE E #154
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-3564
Country	:	US
Telephone Number	:	907-456-6334
Fax Number	:	907-456-6336

Provider Business Practice Location Address
First Line	:	1875 UNIVERSITY AVE S
Second Line	:	#1
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-4906
Country	:	US
Telephone Number	:	907-456-6334
Fax Number	:	907-456-6336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	06/08/2016

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Directions to “ GINA Y ESCOBAR MD” Practice Location

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