Provider Demographics
NPI:1477715381
Name:ESTRADA, JAIME ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ESTEBAN
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 1:6201 NW 58TH WAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4443
Mailing Address - Country:US
Mailing Address - Phone:954-272-8578
Mailing Address - Fax:
Practice Address - Street 1:6201 NW 58TH WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-4443
Practice Address - Country:US
Practice Address - Phone:954-272-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102464208000000X
NY249355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics