Provider Demographics
NPI:1124037122
Name:DIAZ-ESQUIVEL, PABLO R (MD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:R
Last Name:DIAZ-ESQUIVEL
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:P.O. BOX 2485
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-2485
Mailing Address - Country:US
Mailing Address - Phone:806-355-9257
Mailing Address - Fax:806-353-9871
Practice Address - Street 1:1600 COULTER
Practice Address - Street 2:BUILDING E SUITE 703
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1776
Practice Address - Country:US
Practice Address - Phone:806-355-9257
Practice Address - Fax:806-353-9871
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5186207V00000X
MS07297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1116561000OtherFIRST CARE
TXF5186OtherUNICARE
TX034235401Medicaid
TX116561000OtherSOUTHWEST LIFE & HEALTH
TX00JP43OtherBCBS
TX45D1001542OtherCLIA
TXC15233Medicare UPIN
TXF5186OtherUNICARE