Provider Demographics
NPI:1154521490
Name:ESCAMILLA, HECTOR A (MD)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:A
Last Name:ESCAMILLA
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:PO BOX 2540
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2540
Mailing Address - Country:US
Mailing Address - Phone:210-227-5168
Mailing Address - Fax:210-224-6945
Practice Address - Street 1:621 N ALAMO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1836
Practice Address - Country:US
Practice Address - Phone:210-227-5168
Practice Address - Fax:210-224-6945
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0123208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110149502Medicaid
TXB22559Medicare UPIN
TX00J683Medicare PIN
TX110149502Medicaid