Provider Demographics
NPI:1942264643
Name:ESTACIO, RICHMOND L (MD)
Entity Type:Individual
Prefix:
First Name:RICHMOND
Middle Name:L
Last Name:ESTACIO
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 1:3601 W COMMERCIAL BLVD STE 5
Mailing Address - Street 2:ANESCO NORTH BROWARD LLC
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3392
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:3601 W COMMERCIAL BLVD STE 5
Practice Address - Street 2:ANESCO NORTH BROWARD LLC
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3392
Practice Address - Country:US
Practice Address - Phone:954-485-5666
Practice Address - Fax:954-484-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88044207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269653300Medicaid
FL269653300Medicaid
FLU2465ZMedicare PIN