Healthcare Provider Details

I. General information

NPI: 1093068835
Provider Name (Legal Business Name): JORGE MARIO ESCOBAR CAMARGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6624 FANNIN ST STE 2600
HOUSTON TX
77030-2338
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 400
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-7700
  • Fax:
Mailing address:
  • Phone: 713-486-0996
  • Fax: 281-484-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberP4863
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberP4863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: