Healthcare Provider Details

I. General information

NPI: 1770022774
Provider Name (Legal Business Name): DEREK A. ESCALANTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36065 SANTA FE AVE
FORT HOOD TX
76544-5060
US

IV. Provider business mailing address

3320 TEN BITS DR
BELTON TX
76513-1066
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8000
  • Fax:
Mailing address:
  • Phone: 914-582-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number60312
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number31082
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: