Provider Demographics
NPI:1730223017
Name:ESCAMILLA, NORMA L (DO)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:L
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4141
Practice Address - Country:US
Practice Address - Phone:817-335-8478
Practice Address - Fax:817-882-9910
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187153503Medicaid
TX187153502Medicaid
TX187153501Medicaid
TX187153501Medicaid
TXH96285Medicare UPIN
TX187153503Medicaid
TX8J8105Medicare PIN
TX8B2342Medicare ID - Type UnspecifiedMEDICARE