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General NPI Number Information
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NPI Number | 1689868333
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Entity Type | Organization
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Legal Business Name | JUAN CARLOS ESCANDON, INC.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 969 N MASON RD SUITE 140
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6338
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Country | US
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Telephone | 314-996-8830
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Fax | 314-996-8778
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Provider Business Mailing Address
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Address Line | 969 N MASON RD SUITE 140
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6338
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Country | US
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Telephone | 314-996-8830
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Fax | 314-996-8778
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUAN CARLOS ESCANDON
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Credential | M.D.
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Telephone | 314-996-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 106346
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License Number State | MO
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