Healthcare Provider Details

I. General information

NPI: 1053405605
Provider Name (Legal Business Name): ANDREW M. PARAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CALINDA DR
PENSACOLA FL
32506-8372
US

IV. Provider business mailing address

2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SERVICES BLDG. H
JACKSONVILLE FL
32212-0140
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6472
  • Fax:
Mailing address:
  • Phone: 843-228-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24787
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: