Healthcare Provider Details

I. General information

NPI: 1053341024
Provider Name (Legal Business Name): JOSE LUIZ ESCOBAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

PO BOX 241587
MONTGOMERY AL
36124-1587
US

V. Phone/Fax

Practice location:
  • Phone: 334-280-1500
  • Fax: 334-280-1600
Mailing address:
  • Phone: 334-280-1500
  • Fax: 334-280-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15654
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number15654
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number15654
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: