Provider Demographics
NPI:1104929025
Name:ESCALANTE, JOSE ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:777 EAST 25TH STREET
Mailing Address - Street 2:SUITE #214
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-836-1997
Mailing Address - Fax:305-836-7101
Practice Address - Street 1:777 EAST 25TH STREET
Practice Address - Street 2:SUITE #214
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-836-1997
Practice Address - Fax:305-836-7101
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME59927207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263464300Medicaid
FL263464300Medicaid
FL14474ZMedicare PIN