Provider Demographics
NPI:1063510493
Name:ESCOBAR, MARCO R (MD,)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:R
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3957
Mailing Address - Country:US
Mailing Address - Phone:713-663-6322
Mailing Address - Fax:713-663-6944
Practice Address - Street 1:5420 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3957
Practice Address - Country:US
Practice Address - Phone:713-663-6322
Practice Address - Fax:713-663-6944
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5747207Y00000X, 207Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1260OtherBCBS
TX111948905Medicaid
TX760512671OtherEIN
TX8A1260OtherBCBS
TX8C8757Medicare PIN
TX00JE18Medicare PIN
TXB22571Medicare UPIN