Provider Demographics
NPI:1588764591
Name:ESTEVEZ, MIGUEL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:ESTEVEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 RIVERBEND DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8800
Mailing Address - Country:US
Mailing Address - Phone:541-868-9430
Mailing Address - Fax:541-868-9450
Practice Address - Street 1:3355 RIVERBEND DR
Practice Address - Street 2:SUITE 410
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-868-9430
Practice Address - Fax:541-868-9450
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1603372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500652009Medicaid