Provider Demographics
NPI:1982685434
Name:ESCOBAR, EDWARD J (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6400 FANNIN ST STE 2070
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1541
Mailing Address - Country:US
Mailing Address - Phone:713-704-6731
Mailing Address - Fax:713-704-6889
Practice Address - Street 1:6400 FANNIN ST STE 2800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1534
Practice Address - Country:US
Practice Address - Phone:713-704-7100
Practice Address - Fax:713-704-1262
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ64232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153449706OtherMDCD GRP TPI MONTGOMERY COUNTY
TX0035TDOtherBCBSTX GRP PROV REC #
TX00659NOtherMDCR GRP PTAN MONTGOMERY CO
TXDB6392OtherRR MDCR GRP PTAN
TX134275007Medicaid
TX134275007Medicaid