Provider Demographics
NPI:1548371933
Name:ESCOBAR, JUAN RAMON
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:RAMON
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70059-1177
Mailing Address - Country:US
Mailing Address - Phone:504-349-6330
Mailing Address - Fax:
Practice Address - Street 1:4315 HOUMA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2943
Practice Address - Country:US
Practice Address - Phone:504-349-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10264208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5W775Medicare ID - Type Unspecified
LAG25681Medicare UPIN