Healthcare Provider Details

I. General information

NPI: 1447461462
Provider Name (Legal Business Name): JORGE JAVIER ESCOBAR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E BRAVO BLVD
ROMA TX
78584-5720
US

IV. Provider business mailing address

640 E BRAVO BLVD
ROMA TX
78584-5720
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-2176
  • Fax: 956-849-3439
Mailing address:
  • Phone: 956-849-2176
  • Fax: 956-849-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN5042
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN5042
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: