Healthcare Provider Details

I. General information

NPI: 1043214760
Provider Name (Legal Business Name): SUSANA ESCALANTE-GLORSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANA ESCALANTE M.D.

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E. NOLANA AVE STE 4
MCALLEN TX
78504-6113
US

IV. Provider business mailing address

PO BOX 504407
ST LOUIS MO
63150
US

V. Phone/Fax

Practice location:
  • Phone: 956-686-2626
  • Fax: 956-686-1616
Mailing address:
  • Phone: 816-502-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL1029
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2015019922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: