Provider Demographics
NPI:1932631165
Name:ESTRADA, ERIC ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:ESTRADA
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 1:404 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:QUANAH
Mailing Address - State:TX
Mailing Address - Zip Code:79252-4026
Mailing Address - Country:US
Mailing Address - Phone:940-663-6651
Mailing Address - Fax:940-663-5899
Practice Address - Street 1:404 MERCER ST
Practice Address - Street 2:
Practice Address - City:QUANAH
Practice Address - State:TX
Practice Address - Zip Code:79252-4026
Practice Address - Country:US
Practice Address - Phone:940-663-6651
Practice Address - Fax:940-663-5899
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4464207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program