MEDICARE: DR. JOSE D ANDRADE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	18425	PR

General Provider Information

NPI Number	:	1821351446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE D ANDRADE M.D.

Provider Business Mailing Address
First Line	:	10116 S SHARTEL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-5421
Country	:	US
Telephone Number	:	405-703-1747
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 AVE LAS NEREIDAS
Second Line	:
City	:	CATANO
State	:	PR
Zip	:	00962-4418
Country	:	US
Telephone Number	:	787-788-0448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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