Healthcare Provider Details

I. General information

NPI: 1114125408
Provider Name (Legal Business Name): RICARDO ESCAMILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERGQUIST DR SUITE #1
LACKLAND A F B TX
78236-9907
US

IV. Provider business mailing address

6770 COUNTRY FIELD DR
SAN ANTONIO TX
78240-4403
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-7395
  • Fax:
Mailing address:
  • Phone: 210-877-6233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01063953A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: