Provider Demographics
NPI:1609807254
Name:ESCALANTE, ALONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALONSO
Middle Name:
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALONSO
Other - Middle Name:
Other - Last Name:SEMERENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:112 W SPENCER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2546
Mailing Address - Country:US
Mailing Address - Phone:970-641-6788
Mailing Address - Fax:970-641-0282
Practice Address - Street 1:112 W SPENCER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2546
Practice Address - Country:US
Practice Address - Phone:970-641-6788
Practice Address - Fax:970-641-0282
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-45964207X00000X
LAE3688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93683758Medicaid
TX126165301Medicaid
CO841522905OtherBCBS
CO841522905OtherBCBS
TX126165301Medicaid
TXB22560Medicare UPIN