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General NPI Number Information
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NPI Number | 1205962792
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Entity Type | Organization
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Legal Business Name | MEDCOM MEDICAL, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 108 SOUTH BROAD ST.
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City | GLOBE
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State | AZ
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Zip | 85501
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Country | US
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Telephone | 928-425-6592
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Fax | 928-425-7566
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Provider Business Mailing Address
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Address Line | PO BOX 1508
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City | CLAYPOOL
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State | AZ
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Zip | 85539
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Country | US
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Telephone | 928-402-0952
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Fax | 928-402-4774
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Authorized Official
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Title or Position | PRESIDENT
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Name | OSCAR ERNESTO ANDRADE
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Credential | MD
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Telephone | 928-402-0952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 27758
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License Number State | AZ
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