Individual
DR. NEIL CRAINE ESTABROOK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
420 N 26TH ST, LAFAYETTE, IN 47904-2848
(765) 448-8000
(765) 448-7623
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01076841A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001017968
ANTHEM PROVIDER NUMBER
IN
05
—
201101670
—
IN
Enumeration date
03/30/2011
Last updated
02/02/2021
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