Provider Demographics
NPI:1841396025
Name:ESCALANTE, BETHUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHUNE
Middle Name:
Last Name:ESCALANTE
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 1:3791 SYRACUSE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1133
Mailing Address - Country:US
Mailing Address - Phone:713-485-0513
Mailing Address - Fax:713-485-0513
Practice Address - Street 1:3791 SYRACUSE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1133
Practice Address - Country:US
Practice Address - Phone:713-485-0513
Practice Address - Fax:713-485-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1658207R00000X, 2085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine