1255381687 NPI number — JACOB MICHAEL ESTES MD

Table of content: STEFANIE RUTH (NPI 1982838686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255381687 NPI number — JACOB MICHAEL ESTES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTES
Provider First Name:
JACOB
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255381687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 JEFFERSON HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70121-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-842-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70121-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-842-4165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X , with the licence number:  25012 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X , with the licence number: MD.201973 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051109016 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051527934 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 121876 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051530395 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 121891 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051527935 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051530395 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051545189 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1184349 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121881 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121887 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009992175 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051527935 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 04729521 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051527932 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051527934 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009992135 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009992165 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051527933 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051527936 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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