Provider Demographics
NPI:1902869860
Name:DOUGLAS-ESCOBAR, MARTHA VICTORIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:VICTORIA
Last Name:DOUGLAS-ESCOBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-1821
Mailing Address - Country:US
Mailing Address - Phone:415-476-0945
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-8985
Practice Address - Fax:352-273-9004
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN30122080N0001X
CAA935062080N0001X
FLME955132080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004002200Medicaid
TXTXB115705Medicare PIN
FL004002200Medicaid
TX8L15529Medicare PIN