Healthcare Provider Details

I. General information

NPI: 1174556021
Provider Name (Legal Business Name): RICHARD TIMOTHY ESCAJEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10188 N MAIN ST
ARCHDALE NC
27263-2906
US

IV. Provider business mailing address

1701 WESTCHESTER DR STE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2070
  • Fax: 336-802-2071
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95-01236
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: