Provider Demographics
NPI:1922215185
Name:ESCALERA, JAVIER PONCE (MD, MS)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:PONCE
Last Name:ESCALERA
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:583 YORKS XING
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-5759
Mailing Address - Country:US
Mailing Address - Phone:512-722-3285
Mailing Address - Fax:
Practice Address - Street 1:3625 MANCHACA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6631
Practice Address - Country:US
Practice Address - Phone:512-557-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA953442084P0800X
TXM71692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry