1023011749 NPI number — DR. DIEGO P ANDRADE M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023011749 NPI number — DR. DIEGO P ANDRADE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDRADE
Provider First Name:
DIEGO
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023011749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4048 EVANS AVE
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
FT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33901-9390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-332-5344
Provider Business Mailing Address Fax Number:
239-332-7246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4048 EVANS AVE
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
FT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-9390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-332-5344
Provider Business Practice Location Address Fax Number:
239-332-7246
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  ME0087283 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0867335 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29149Z . This is a "MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266586700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00032667 . This is a "MCRR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3127321 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29149 . This is a "BSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100894800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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