Provider Demographics
NPI:1225134745
Name:ECHEVARRIA, ESTHER (MD)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:ECHEVARRIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1105
Mailing Address - Country:US
Mailing Address - Phone:863-619-5100
Mailing Address - Fax:863-619-5102
Practice Address - Street 1:3810 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1105
Practice Address - Country:US
Practice Address - Phone:863-619-5100
Practice Address - Fax:863-619-5102
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN839208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15330OtherMD LICENCE
PR7000007637OtherETIN MEDICARE NO.
FLACN839OtherMEDICAL LICENSE
PR15330OtherMD LICENCE
FLACN839OtherMEDICAL LICENSE