Healthcare Provider Details

I. General information

NPI: 1881622181
Provider Name (Legal Business Name): DIEGO ESCOBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DIEGO ESCOBAR MD

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 430
TAMPA FL
33613-4681
US

IV. Provider business mailing address

6989 E FOWLER AVE
TEMPLE TERRACE FL
33617-1714
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7160
  • Fax: 813-615-7173
Mailing address:
  • Phone: 813-935-4210
  • Fax: 813-932-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number236217
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME156375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: