MEDICARE: DR. JUAN A ESCOBALES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME27676	FL
2	174400000X	Specialist	ME27676	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275519480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN A ESCOBALES M.D.

Provider Business Mailing Address
First Line	:	2815 FIRST AVENUE NORTH
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8603
Country	:	US
Telephone Number	:	727-321-9614
Fax Number	:	727-323-7068

Provider Business Practice Location Address
First Line	:	2815 FIRST AVENUE NORTH
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8603
Country	:	US
Telephone Number	:	727-321-9614
Fax Number	:	727-323-7068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	08/13/2021

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