MEDICARE: DR. MICHAEL SCOTT ESCOBEDO 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	208D00000X	General Practice Physician	5327641-1205	UT

General Provider Information

NPI Number	:	1538219233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT ESCOBEDO M.D.

Provider Business Mailing Address
First Line	:	2312 WESTERN TRAILS BLVD
Second Line	:	#103
City	:	AUSTIN
State	:	TX
Zip	:	78745-1642
Country	:	US
Telephone Number	:	512-347-9794
Fax Number	:	512-442-7300

Provider Business Practice Location Address
First Line	:	2312 WESTERN TRAILS BLVD
Second Line	:	#103
City	:	AUSTIN
State	:	TX
Zip	:	78745-1642
Country	:	US
Telephone Number	:	512-347-9794
Fax Number	:	512-442-7300

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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