Provider Demographics
NPI:1558346544
Name:ESCORCIA, FREDDY A (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:A
Last Name:ESCORCIA
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 1:117 HEATHERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-4890
Mailing Address - Country:US
Mailing Address - Phone:309-387-2733
Mailing Address - Fax:309-387-2733
Practice Address - Street 1:117 HEATHERVIEW DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-4890
Practice Address - Country:US
Practice Address - Phone:309-387-2733
Practice Address - Fax:309-387-2733
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092303207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO036092303Medicaid
IL210426010Medicare PIN
COL96198Medicare ID - Type Unspecified
COG53196Medicare UPIN