Provider Demographics
NPI:1851493605
Name:ESCOBEDO, LUIS GERARDO (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GERARDO
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 SOMBRA VERDE
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-8572
Mailing Address - Country:US
Mailing Address - Phone:915-471-9633
Mailing Address - Fax:
Practice Address - Street 1:1610 N ZARAGOZA RD STE D1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7918
Practice Address - Country:US
Practice Address - Phone:915-593-1862
Practice Address - Fax:915-593-2173
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG61642083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine