Provider Demographics
NPI:1265607550
Name:ESTES, DARRYL BRADLEY
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:BRADLEY
Last Name:ESTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2699
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-9527
Mailing Address - Country:US
Mailing Address - Phone:276-346-4180
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2699
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-9527
Practice Address - Country:US
Practice Address - Phone:276-346-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA012373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
190001290Medicare Oscar/Certification