Provider Demographics
NPI:1962560268
Name:ESCOBAR, GINA Y (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:Y
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3875 GEIST RD
Mailing Address - Street 2:SUITE E #154
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3564
Mailing Address - Country:US
Mailing Address - Phone:907-456-6334
Mailing Address - Fax:907-456-6336
Practice Address - Street 1:1875 UNIVERSITY AVE S
Practice Address - Street 2:#1
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4906
Practice Address - Country:US
Practice Address - Phone:907-456-6334
Practice Address - Fax:907-456-6336
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKMD4347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152024Medicare ID - Type Unspecified
AKMD26201Medicaid
406551Medicare UPIN