Provider Demographics
NPI:1316184302
Name:ESCANDON, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:ESCANDON
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 1:1300 S BRYAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6688
Mailing Address - Country:US
Mailing Address - Phone:956-519-9333
Mailing Address - Fax:956-519-9353
Practice Address - Street 1:1300 S BRYAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-519-9333
Practice Address - Fax:956-519-9353
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10031280207R00000X
TXP1994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307309003Medicaid
TX307309001Medicaid