Provider Demographics
NPI:1144424920
Name:ESCOBAR, JOSE FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
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 1:2505 SCRIPTURE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2376
Mailing Address - Country:US
Mailing Address - Phone:940-323-3655
Mailing Address - Fax:
Practice Address - Street 1:2505 SCRIPTURE ST STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2376
Practice Address - Country:US
Practice Address - Phone:940-323-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5150208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194031404Medicaid
TX194031403Medicaid
TX526960YKP5Medicare PIN
TXTXB113086Medicare PIN
TX194031404Medicaid
TX194031403Medicaid
TXTXB113013Medicare PIN