Healthcare Provider Details

I. General information

NPI: 1477715381
Provider Name (Legal Business Name): JAIME ESTEBAN ESTRADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 S FEDERAL HWY
FORT LAUDERDALE FL
33316-1218
US

IV. Provider business mailing address

789 S FEDERAL HWY
FORT LAUDERDALE FL
33316-1218
US

V. Phone/Fax

Practice location:
  • Phone: 954-315-5784
  • Fax:
Mailing address:
  • Phone: 954-315-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 102464
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number249355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: