Healthcare Provider Details

I. General information

NPI: 1972539229
Provider Name (Legal Business Name): ENRICO G ESGUERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 EAST 34TH ST. #103
JOPLIN MO
64804
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-1288
  • Fax: 417-347-1230
Mailing address:
  • Phone: 417-347-1288
  • Fax: 417-347-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number115095
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: