Healthcare Provider Details

I. General information

NPI: 1346281557
Provider Name (Legal Business Name): EDWIN ESCOBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 N BUCKNER BLVD STE 100
DALLAS TX
75228-5633
US

IV. Provider business mailing address

3010 LYNDON B JOHNSON FWY FL 1200
DALLAS TX
75234-2710
US

V. Phone/Fax

Practice location:
  • Phone: 214-660-1011
  • Fax: 214-716-7236
Mailing address:
  • Phone: 214-716-7236
  • Fax: 214-716-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ1085
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: