1215937404 NPI number — DR. PAUL R ESGUERRA M.D.

Table of content: DR. PAUL R ESGUERRA M.D. (NPI 1215937404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215937404 NPI number — DR. PAUL R ESGUERRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESGUERRA
Provider First Name:
PAUL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215937404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2125 E STATE HIGHWAY 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINTON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47441-9407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-847-8711
Provider Business Mailing Address Fax Number:
812-847-8793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 E STATE HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47441-9407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-847-8711
Provider Business Practice Location Address Fax Number:
812-847-8793
Provider Enumeration Date:
07/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QA0000X , with the licence number: 01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: 01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: 01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X , with the licence number: 01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 01039089 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100125020 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000089459 . This is a "BC/BS #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".