Provider Demographics
NPI:1285746511
Name:ESTES, TIMOTHY DUNCAN (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DUNCAN
Last Name:ESTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 MCDOWELL ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4238
Mailing Address - Country:US
Mailing Address - Phone:601-372-1117
Mailing Address - Fax:601-373-3004
Practice Address - Street 1:2860 MCDOWELL ROAD EXT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4238
Practice Address - Country:US
Practice Address - Phone:601-372-1117
Practice Address - Fax:601-373-3004
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09740208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00017048Medicaid
MS110065028OtherRAILROAD MEDICARE
MSD80638Medicare UPIN
MS00017048Medicaid