Provider Demographics
NPI:1578572558
Name:PABLO R. DIAZ-ESQUIVEL MD PA
Entity Type:Organization
Organization Name:PABLO R. DIAZ-ESQUIVEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-355-9257
Mailing Address - Street 1:P.O. BOX 2485
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105
Mailing Address - Country:US
Mailing Address - Phone:806-355-9257
Mailing Address - Fax:806-353-9871
Practice Address - Street 1:1600 COULTER
Practice Address - Street 2:BUILDING E SUITE 703
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-355-9257
Practice Address - Fax:806-353-9871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
TXF5186207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JP43OtherBCBS
TX034235401Medicaid
TX45D1001542OtherCLIA
TXC15233Medicare UPIN
TX00JP43Medicare ID - Type Unspecified