Provider Demographics
NPI:1063723831
Name:ESCOVAR, RAPHAEL MORENO (MD)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:MORENO
Last Name:ESCOVAR
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 1:2600 HIGHWAY 118 NORTH
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830
Mailing Address - Country:US
Mailing Address - Phone:432-837-0430
Mailing Address - Fax:432-837-0848
Practice Address - Street 1:2600 N HIGHWAY 118
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-2002
Practice Address - Country:US
Practice Address - Phone:432-837-0430
Practice Address - Fax:432-837-0848
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT197231207Q00000X
TXP6811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine