Healthcare Provider Details

I. General information

NPI: 1477724482
Provider Name (Legal Business Name): DAVID A. ESCALANTE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 CUMBERLAND AVE
MIDDLESBORO KY
40965-1378
US

IV. Provider business mailing address

PO BOX 1795
MIDDLESBORO KY
40965-3795
US

V. Phone/Fax

Practice location:
  • Phone: 606-242-2196
  • Fax: 606-242-2586
Mailing address:
  • Phone: 606-242-2196
  • Fax: 606-242-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A ESCALANTE
Title or Position: OWNER
Credential: MD
Phone: 606-242-2196