MEDICARE: JAVIER PONCE ESCALERA M.D., M.S.

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	A95344	CA
2	2084P0800X	Psychiatry Physician	M7169	TX

General Provider Information

NPI Number	:	1922215185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER PONCE ESCALERA M.D., M.S.

Provider Business Mailing Address
First Line	:	583 YORKS XING
Second Line	:
City	:	DRIFTWOOD
State	:	TX
Zip	:	78619-5759
Country	:	US
Telephone Number	:	512-722-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 MANCHACA RD
Second Line	:	SUITE 202
City	:	AUSTIN
State	:	TX
Zip	:	78704-6631
Country	:	US
Telephone Number	:	512-557-0947
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	05/15/2008

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