Healthcare Provider Details

I. General information

NPI: 1700877446
Provider Name (Legal Business Name): JORGE V ESGUERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW RADIOLOGY ASSOCIATES OF CANTON, INC.
CANTON OH
44711
US

IV. Provider business mailing address

P.O. BOX 72384 RADIOLOGY ASSOCIATES OF CANTON, INC.
CLEVELAND OH
44192
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-2842
  • Fax: 330-580-5536
Mailing address:
  • Phone: 888-686-1837
  • Fax: 330-686-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35 04 1922E
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35 04 1992E
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: