Provider Demographics
NPI:1851580062
Name:ESTES, TOD IRWIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TOD
Middle Name:IRWIN
Last Name:ESTES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:403 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:OK
Mailing Address - Zip Code:74016-1453
Mailing Address - Country:US
Mailing Address - Phone:918-789-3146
Mailing Address - Fax:918-789-5650
Practice Address - Street 1:403 REDBUD LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:OK
Practice Address - Zip Code:74016-1453
Practice Address - Country:US
Practice Address - Phone:918-789-3146
Practice Address - Fax:918-789-5650
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123860AMedicaid
OK200123860AMedicaid
OK243803202Medicare PIN