Individual
GREGORY LANE ESTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7930 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2691
(317) 621-6725
(317) 621-4545
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01052313A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01052313A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000764708
ANTHEM
IN
05
—
200258160
—
IN
01
—
P01133603
MEDICARE RAILROAD
IN
Enumeration date
07/10/2006
Last updated
11/27/2023
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