Healthcare Provider Details

I. General information

NPI: 1215937404
Provider Name (Legal Business Name): PAUL R ESGUERRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E STATE HIGHWAY 54
LINTON IN
47441-9407
US

IV. Provider business mailing address

2125 E STATE HIGHWAY 54
LINTON IN
47441-9407
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-8711
  • Fax: 812-847-8793
Mailing address:
  • Phone: 812-847-8711
  • Fax: 812-847-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01039089
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number01039089
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01039089
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number01039089
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number01039089
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01039089
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: