Provider Demographics
NPI:1134248776
Name:ESTES, WAYNE P (PA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:P
Last Name:ESTES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 ATWOOD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3289
Mailing Address - Country:US
Mailing Address - Phone:401-273-9400
Mailing Address - Fax:401-273-2339
Practice Address - Street 1:1526 ATWOOD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3289
Practice Address - Country:US
Practice Address - Phone:401-273-9400
Practice Address - Fax:401-273-2339
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI452083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine