Provider Demographics
NPI:1639150410
Name:ESCAMILLA, CLAIRE ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELLEN
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2821
Mailing Address - Country:US
Mailing Address - Phone:210-843-4649
Mailing Address - Fax:
Practice Address - Street 1:202 S FM 1346 STE 2
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-4282
Practice Address - Country:US
Practice Address - Phone:830-779-3200
Practice Address - Fax:830-779-3211
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3563207P00000X
NMMD2019-0842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030903101Medicaid
TX8N2664OtherBCBS
TX355698YLITOtherMEDICARE PTAN
TX8DW811OtherBCBSTX
TX355698YLITOtherMEDICARE PTAN
TX00687LMedicare PIN
TX8N2664OtherBCBS