Provider Demographics
NPI:1427096551
Name:ESCALANTE, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ESCALANTE
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 1:292 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2132
Mailing Address - Country:US
Mailing Address - Phone:423-784-3600
Mailing Address - Fax:423-784-4602
Practice Address - Street 1:292 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2132
Practice Address - Country:US
Practice Address - Phone:423-784-3600
Practice Address - Fax:423-784-4602
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25677207P00000X, 207RE0101X
TNMD0000025677207R00000X
KY30671207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100010513Medicaid
TN3117289Medicaid
KY64920259Medicaid
TN0200243OtherBCBST
TN3088412Medicaid
TN3088416Medicaid
TN4102780OtherBCBS OF TN
TNTN0102Medicaid
TNTN0102OtherCOMMERCIAL
TN3088416Medicaid
KY64920259Medicaid
TNTN0102OtherCOMMERCIAL
TNTN0102Medicaid