Healthcare Provider Details

I. General information

NPI: 1952479735
Provider Name (Legal Business Name): E & S FAMILY MEDICINE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 1ST AVE N
ST PETERSBURG FL
33713-8603
US

IV. Provider business mailing address

2815 1ST AVE N
ST PETERSBURG FL
33713-8603
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-9614
  • Fax: 727-323-7068
Mailing address:
  • Phone: 727-321-9614
  • Fax: 727-323-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME27676
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88883
License Number StateFL

VIII. Authorized Official

Name: DR. JUAN A ESCOBALES
Title or Position: DOCTOR
Credential: M.D.
Phone: 727-321-9614