Provider Demographics
NPI:1467590141
Name:PEDRO E. ESTORQUE JR., M.D., P.A.
Entity Type:Organization
Organization Name:PEDRO E. ESTORQUE JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:ESMERALDA
Authorized Official - Last Name:ESTORQUE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:940-320-0505
Mailing Address - Street 1:2625 SCRIPTURE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2301
Mailing Address - Country:US
Mailing Address - Phone:940-320-0505
Mailing Address - Fax:940-320-0506
Practice Address - Street 1:2625 SCRIPTURE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2301
Practice Address - Country:US
Practice Address - Phone:940-320-0505
Practice Address - Fax:940-320-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104386104Medicaid
TX175614001Medicaid
TX8F0440Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX175614001Medicaid
TX104386104Medicaid