Provider Demographics
NPI:1154429066
Name:BECERRA ESCOBAR, JESUS SR (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:BECERRA ESCOBAR
Suffix:SR
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:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681
Mailing Address - Country:US
Mailing Address - Phone:787-834-4340
Mailing Address - Fax:787-265-7750
Practice Address - Street 1:CONDOMINIO LA PALMA PERAL 14
Practice Address - Street 2:SUITE 2-G
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-4340
Practice Address - Fax:787-265-7750
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9473207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083688Medicare ID - Type Unspecified
F73881Medicare UPIN