Provider Demographics
NPI:1558399048
Name:ESTES, STEPHEN SANDFORD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SANDFORD
Last Name:ESTES
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 1:7215 CHATSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2363
Mailing Address - Country:US
Mailing Address - Phone:941-896-2150
Mailing Address - Fax:
Practice Address - Street 1:10910 E STATE ROAD 70
Practice Address - Street 2:SUITE 102 LWR FAMILY PRACTICE WALK-IN
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8406
Practice Address - Country:US
Practice Address - Phone:941-896-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93041207V00000X
FLME93041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274073700Medicaid
FL274073700Medicaid
FL31005UMedicare UPIN
FL#31005YMedicare PIN