Provider Demographics
NPI:1841221330
Name:ESTORES, IRENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:M
Last Name:ESTORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:LY
Other - Last Name:MISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:SHANDS HOSPITAL, ROOM 4123
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:SHANDS HOSPITAL, ROOM 4123
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0277
Practice Address - Country:US
Practice Address - Phone:352-265-0651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78535208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009096200Medicaid
FL009096200Medicaid