Healthcare Provider Details

I. General information

NPI: 1275095036
Provider Name (Legal Business Name): LUIS ERNESTO ESCOBEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SOMBRA VERDE
ANTHONY NM
88021-8572
US

IV. Provider business mailing address

310 SOMBRA VERDE
ANTHONY NM
88021-8572
US

V. Phone/Fax

Practice location:
  • Phone: 915-490-0940
  • Fax:
Mailing address:
  • Phone: 915-490-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0068737
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: