Basic Information
| Provider Information | |||||||||
| NPI: | 1265425417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESTEVEZ | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | MIGUEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 18TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337044605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173856186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 160 COWLES ST | ||||||||
| Address2: | FAIRBANKS MEMORIAL HOSPITAL | ||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997014459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074585525 | ||||||||
| FaxNumber: | 9074585514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 3507 | AK | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.