Healthcare Provider Details

I. General information

NPI: 1952868630
Provider Name (Legal Business Name): MR. WILLIAM JASON ESTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JOSHUA CIR APT 52
BEREA KY
40403-9051
US

IV. Provider business mailing address

100 JOSHUA CIR APT 52
BEREA KY
40403-9051
US

V. Phone/Fax

Practice location:
  • Phone: 606-312-9194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: