Healthcare Provider Details

I. General information

NPI: 1164732996
Provider Name (Legal Business Name): MIGUEL ANGEL ESCOBEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUNLAND PARK DR STE 200
EL PASO TX
79912-5141
US

IV. Provider business mailing address

601 SUNLAND PARK DR STE 200
EL PASO TX
79912-5141
US

V. Phone/Fax

Practice location:
  • Phone: 915-834-5951
  • Fax:
Mailing address:
  • Phone: 915-834-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG9025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: