Basic Information
| Provider Information | |||||||||
| NPI: | 1851493605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCOBEDO | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | GERARDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 SOMBRA VERDE | ||||||||
| Address2: | |||||||||
| City: | ANTHONY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880218572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154719633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1610 N ZARAGOZA RD STE D1 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799367918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155931862 | ||||||||
| FaxNumber: | 9155932173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 12/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | G6164 | TX | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.