MEDICARE: RANDY ESTACION FLORENDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD31309	TN
2	207P00000X	Emergency Medicine Physician	MD31309	TN
3	207P00000X	Emergency Medicine Physician	49518	KY
4	207R00000X	Internal Medicine Physician	31309	TN
5	207R00000X	Internal Medicine Physician	49518	KY
6	208000000X	Pediatrics Physician	MD31309	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4108174	OTHER	TN	TENN CARE

General Provider Information

NPI Number	:	1235124207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY ESTACION FLORENDO MD

Provider Business Mailing Address
First Line	:	832 SAVANNAH WEST CT
Second Line	:	SUITE F
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-7387
Country	:	US
Telephone Number	:	615-643-5008
Fax Number	:	615-643-4100

Provider Business Practice Location Address
First Line	:	832 SAVANNAH WEST CT
Second Line	:	SUITE F
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172
Country	:	US
Telephone Number	:	615-483-6675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/02/2023

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