Provider Demographics
NPI:1548263593
Name:ESTORQUE, PEDRO ESMERALDA JR (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ESMERALDA
Last Name:ESTORQUE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 FORT WORTH DR STE 140
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-7527
Mailing Address - Country:US
Mailing Address - Phone:940-320-0505
Mailing Address - Fax:940-320-0506
Practice Address - Street 1:500 FORT WORTH DR STE 140
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-7527
Practice Address - Country:US
Practice Address - Phone:940-320-0505
Practice Address - Fax:940-320-0506
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2023-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104386104Medicaid
TXG09608Medicare UPIN
TX104386104Medicaid