Provider Demographics
NPI:1023011749
Name:ANDRADE, DIEGO P (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:P
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 EVANS AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9390
Mailing Address - Country:US
Mailing Address - Phone:239-332-5344
Mailing Address - Fax:239-332-7246
Practice Address - Street 1:4048 EVANS AVE
Practice Address - Street 2:STE 303
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9390
Practice Address - Country:US
Practice Address - Phone:239-332-5344
Practice Address - Fax:239-332-7246
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0087283207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0867335OtherCIGNA
FL29149ZOtherMCR
FL266586700Medicaid
FLP00032667OtherMCRR
FL3127321OtherAETNA
FL29149OtherBSFL
FL29149OtherBSFL