Provider Demographics
NPI:1609663681
Name:ESCOBAR, GEORGE
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 SOMMERVILLE PLACE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-4225
Mailing Address - Country:US
Mailing Address - Phone:707-291-7788
Mailing Address - Fax:
Practice Address - Street 1:7621 SOMMERVILLE PLACE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-4225
Practice Address - Country:US
Practice Address - Phone:707-291-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist