Provider Demographics
NPI:1184665119
Name:ESTRADA, JASON K (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:K
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1910 SASSAFRAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:412-937-8887
Mailing Address - Fax:412-937-9221
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5980
Practice Address - Fax:814-452-5039
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD418258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001339337OtherHIGHMARK BCBS
PA001339337OtherHIGHMARK BCBS