Healthcare Provider Details

I. General information

NPI: 1134583628
Provider Name (Legal Business Name): JOHN ESCOBEDO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 MEDICAL DR
SAN ANTONIO TX
78229-4403
US

IV. Provider business mailing address

301 FISHER ST
BILOXI MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-8145
  • Fax:
Mailing address:
  • Phone: 228-376-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29715
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR5386
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: