Provider Demographics
NPI:1376646620
Name:ESPINOZA, LUIS E (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:ESPINOZA
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 1:200 COMMODORE ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2903
Mailing Address - Country:US
Mailing Address - Phone:620-672-7451
Mailing Address - Fax:620-672-2113
Practice Address - Street 1:124 COMMODORE ST STE B
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124
Practice Address - Country:US
Practice Address - Phone:620-672-6454
Practice Address - Fax:620-672-3488
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS263005662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist