Provider Demographics
NPI:1912999079
Name:ESTES, GLEN B (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:B
Last Name:ESTES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7575 JEFFERSON HWY
Mailing Address - Street 2:#87
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8308
Mailing Address - Country:US
Mailing Address - Phone:225-927-3062
Mailing Address - Fax:225-927-7740
Practice Address - Street 1:4521 JAMESTOWN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3234
Practice Address - Country:US
Practice Address - Phone:225-927-3062
Practice Address - Fax:225-927-7740
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA4356R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309800Medicaid
LAB62764Medicare UPIN
LA1309800Medicaid