Provider Demographics
NPI:1275095036
Name:ESCOBEDO, LUIS ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ERNESTO
Last Name:ESCOBEDO
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 1:310 SOMBRA VERDE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8572
Mailing Address - Country:US
Mailing Address - Phone:915-490-0940
Mailing Address - Fax:
Practice Address - Street 1:310 SOMBRA VERDE
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-8572
Practice Address - Country:US
Practice Address - Phone:915-490-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
CO0068737208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program