Provider Demographics
NPI:1689868333
Name:JUAN CARLOS ESCANDON, INC.
Entity Type:Organization
Organization Name:JUAN CARLOS ESCANDON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ESCANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-996-8830
Mailing Address - Street 1:969 N MASON RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6338
Mailing Address - Country:US
Mailing Address - Phone:314-996-8830
Mailing Address - Fax:314-996-8778
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-996-8830
Practice Address - Fax:314-996-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1063462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG69498Medicare UPIN