Healthcare Provider Details

I. General information

NPI: 1134248776
Provider Name (Legal Business Name): WAYNE P ESTES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 ATWOOD AVE SUITE 100
JOHNSTON RI
02919-3289
US

IV. Provider business mailing address

1526 ATWOOD AVE SUITE 100
JOHNSTON RI
02919-3289
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-9400
  • Fax: 401-273-2339
Mailing address:
  • Phone: 401-273-9400
  • Fax: 401-273-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number45
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: