Provider Demographics
NPI:1164460762
Name:ESGUERRA, EDEN M (MD)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:M
Last Name:ESGUERRA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-6813
Mailing Address - Fax:417-556-6849
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:SUITE 470
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-6813
Practice Address - Fax:417-556-6849
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO105727207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207829805Medicaid
MOP00817797OtherRAIL ROAD MEDICARE
OK1002250000AMedicaid
KS100172270DMedicaid
MOP00817797OtherRAIL ROAD MEDICARE
F82177Medicare UPIN