Provider Demographics
NPI:1831185602
Name:ESCOBAR, LUIS ALCIDES (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALCIDES
Last Name:ESCOBAR
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 1:3510 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8129
Mailing Address - Country:US
Mailing Address - Phone:954-322-8586
Mailing Address - Fax:954-322-8581
Practice Address - Street 1:4350 SHERIDAN ST STE 102
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3556
Practice Address - Country:US
Practice Address - Phone:954-322-8586
Practice Address - Fax:954-322-8581
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58000174400000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12692OtherBCBS
FLK5939AMedicare PIN
FL12692OtherBCBS
FL12692UMedicare ID - Type Unspecified
FL12692TMedicare PIN
FLK5939Medicare PIN