Provider Demographics
NPI:1346236189
Name:ESTRADA, RUBEN CASTRO (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:CASTRO
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 AVERY ST STE 501
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5192
Mailing Address - Country:US
Mailing Address - Phone:304-588-8683
Mailing Address - Fax:304-422-3924
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2590
Practice Address - Fax:304-422-3924
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061294207L00000X
WV15941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0758970Medicaid
WV0058734000Medicaid
OH0758970Medicaid
0655414Medicare ID - Type Unspecified
0655411Medicare ID - Type Unspecified
0655415Medicare ID - Type Unspecified
D74907Medicare UPIN