Healthcare Provider Details

I. General information

NPI: 1427096551
Provider Name (Legal Business Name): DAVID ESCALANTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 N MAIN ST
JELLICO TN
37762-2132
US

IV. Provider business mailing address

292 N MAIN ST
JELLICO TN
37762-2132
US

V. Phone/Fax

Practice location:
  • Phone: 423-784-3600
  • Fax: 423-784-4602
Mailing address:
  • Phone: 423-784-3600
  • Fax: 423-784-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25677
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000025677
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number30671
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: