Healthcare Provider Details

I. General information

NPI: 1184983496
Provider Name (Legal Business Name): VICTOR IVAN ESCOBAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 CYPRESS CREEK PKWY SUITE 105
HOUSTON TX
77090-3423
US

IV. Provider business mailing address

20320 NORTHWEST FWY SUITE 900
JERSEY VILLAGE TX
77065-5641
US

V. Phone/Fax

Practice location:
  • Phone: 281-586-3888
  • Fax: 281-440-2020
Mailing address:
  • Phone: 281-453-7232
  • Fax: 281-440-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10043365
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: