Healthcare Provider Details

I. General information

NPI: 1538219233
Provider Name (Legal Business Name): MICHAEL SCOTT ESCOBEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WESTERN TRAILS BLVD #103
AUSTIN TX
78745-1642
US

IV. Provider business mailing address

2312 WESTERN TRAILS BLVD #103
AUSTIN TX
78745-1642
US

V. Phone/Fax

Practice location:
  • Phone: 512-347-9794
  • Fax: 512-442-7300
Mailing address:
  • Phone: 512-347-9794
  • Fax: 512-442-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5327641-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: