Healthcare Provider Details

I. General information

NPI: 1598855694
Provider Name (Legal Business Name): JOSE DAN OCTOSO ESCARDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR PMR&S(117/NLR)
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2200 FORT ROOTS DR PMR&S(117/NLR)
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-2992
  • Fax: 501-257-2993
Mailing address:
  • Phone: 501-257-2992
  • Fax: 501-257-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberE-3057
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: