Basic Information
Provider Information
NPI: 1952952400
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESTOQUE
FirstName: ARTHUR
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1509 DULLES DR
Address2:  
City: LAFAYETTE
State: LA
PostalCode: 705063718
CountryCode: US
TelephoneNumber: 3379919276
FaxNumber: 3379430846
Practice Location
Address1: 1 PERIMETER PARK S STE 100N
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352433248
CountryCode: US
TelephoneNumber: 3379919276
FaxNumber: 3379430846
Other Information
ProviderEnumerationDate: 09/26/2019
LastUpdateDate: 09/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LG0600X1-108400ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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