Healthcare Provider Details

I. General information

NPI: 1316184302
Provider Name (Legal Business Name): JOSE ESCANDON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S BRYAN RD STE 100
MISSION TX
78572-6688
US

IV. Provider business mailing address

1300 S BRYAN RD STE 100
MISSION TX
78572-6688
US

V. Phone/Fax

Practice location:
  • Phone: 956-519-9333
  • Fax: 956-519-9353
Mailing address:
  • Phone: 956-519-9333
  • Fax: 956-519-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10031280
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP1994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: