Provider Demographics
NPI:1396792065
Name:ESTRADA, JAIME (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8109 FREDERICKSBURG RD
Mailing Address - Street 2:PHYSICIAN PRACTICE SERVICES
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3311
Mailing Address - Country:US
Mailing Address - Phone:210-575-6240
Mailing Address - Fax:210-575-6280
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:STE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3755
Practice Address - Country:US
Practice Address - Phone:210-575-6240
Practice Address - Fax:210-575-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG2361207RH0000X, 208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133046612Medicaid
TX133046613OtherCSHCN
TX8BX389OtherBCBS
TX133046612Medicaid