Provider Demographics
NPI:1982628566
Name:ROBERT J ESTRADA DPM PA
Entity Type:Organization
Organization Name:ROBERT J ESTRADA DPM PA
Other - Org Name:DBA METROWEST FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-299-1335
Mailing Address - Street 1:1803 PARK CENTER DR
Mailing Address - Street 2:STE 210
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6216
Mailing Address - Country:US
Mailing Address - Phone:407-299-1335
Mailing Address - Fax:407-299-1835
Practice Address - Street 1:1803 PARK CENTER DR
Practice Address - Street 2:STE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6216
Practice Address - Country:US
Practice Address - Phone:407-299-1335
Practice Address - Fax:407-299-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2092213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF0289OtherRAIL ROAD MEDICARE GROUP PROV. #
FLDF0289OtherRAIL ROAD MEDICARE GROUP PROV. #
FLU19689Medicare UPIN
FL5796410001Medicare NSC