Healthcare Provider Details

I. General information

NPI: 1124099528
Provider Name (Legal Business Name): MARIAN PILAR ESCOBAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W IOWA AVE
CHICKASHA OK
73018-2738
US

IV. Provider business mailing address

PO BOX 1069
CHICKASHA OK
73023-1069
US

V. Phone/Fax

Practice location:
  • Phone: 405-224-8111
  • Fax: 405-222-5359
Mailing address:
  • Phone: 405-224-8111
  • Fax: 405-222-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11327
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: