MEDICARE: DANIEL M. ESCALONA, M.D. A MEDICAL LLC

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	2084P0800X	Psychiatry Physician	06454R	LA

General Provider Information

NPI Number	:	1750494845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL M. ESCALONA, M.D. A MEDICAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 80754
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70598-0754
Country	:	US
Telephone Number	:	337-269-5595
Fax Number	:	337-269-0897

Provider Business Practice Location Address
First Line	:	102 COULEE SHORE DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3021
Country	:	US
Telephone Number	:	337-269-5595
Fax Number	:	337-269-0897

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL M. ESCALONA
Credential	:	M.D.
Telephone Number	:	337-269-5595

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	05/16/2011

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