Provider Demographics
NPI:1952479735
Name:E & S FAMILY MEDICINE PHYSICIANS
Entity Type:Organization
Organization Name:E & S FAMILY MEDICINE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESCOBALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-321-9614
Mailing Address - Street 1:2815 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8603
Mailing Address - Country:US
Mailing Address - Phone:727-321-9614
Mailing Address - Fax:727-323-7068
Practice Address - Street 1:2815 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8603
Practice Address - Country:US
Practice Address - Phone:727-321-9614
Practice Address - Fax:727-323-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME27676207Q00000X
FLME88883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0124Medicare ID - Type Unspecified