Provider Demographics
NPI:1699723726
Name:ESTRADA, ROBERT JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:STE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3771
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:1261 BLACKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761
Practice Address - Country:US
Practice Address - Phone:407-877-2900
Practice Address - Fax:407-877-0193
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2092213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002088900Medicaid
FLP00838709OtherRAILROAD MEDICARE PROVIDER NUMBER
FL5796410001Medicare NSC
FLP00838709OtherRAILROAD MEDICARE PROVIDER NUMBER
FL65190XMedicare PIN