Provider Demographics
NPI:1518305044
Name:ESCOBAR, JIMMY (ŇD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:ŇD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 STATE ROAD 7
Mailing Address - Street 2:SUITE B1
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5876
Mailing Address - Country:US
Mailing Address - Phone:954-907-4325
Mailing Address - Fax:
Practice Address - Street 1:4469 STATE ROAD 7
Practice Address - Street 2:SUITE B1
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-5876
Practice Address - Country:US
Practice Address - Phone:954-907-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTND100173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist