Provider Demographics
NPI:1215937404
Name:ESGUERRA, PAUL R (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:ESGUERRA
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 1:2125 E STATE HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-9407
Mailing Address - Country:US
Mailing Address - Phone:812-847-8711
Mailing Address - Fax:812-847-8793
Practice Address - Street 1:2125 E STATE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9407
Practice Address - Country:US
Practice Address - Phone:812-847-8711
Practice Address - Fax:812-847-8793
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039089207Q00000X, 207QA0000X, 207QA0401X, 207QA0505X, 207QG0300X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100125020Medicaid
IN000000089459OtherBC/BS #
IN10075183Medicare PIN
IN301520Medicare PIN
IN100125020Medicaid