Healthcare Provider Details

I. General information

NPI: 1548884596
Provider Name (Legal Business Name): ALEX JR ESCOBAL NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W HALSELL ST
DIMMITT TX
79027-1846
US

IV. Provider business mailing address

621 STAR ST
HEREFORD TX
79045-3405
US

V. Phone/Fax

Practice location:
  • Phone: 806-647-2191
  • Fax:
Mailing address:
  • Phone: 806-673-5737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP146162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: