Provider Demographics
NPI:1073504312
Name:GUILLAUME, ANDAMO A (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDAMO
Middle Name:A
Last Name:GUILLAUME
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 1:19026 STONE OAK PARKWAY
Mailing Address - Street 2:SUITE #220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-614-5600
Mailing Address - Fax:210-614-8963
Practice Address - Street 1:8715 VILLAGE DRIVE
Practice Address - Street 2:SUITE 618
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-614-5600
Practice Address - Fax:210-614-8963
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8186207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030716702Medicaid
TX030716702Medicaid
TX8342B0Medicare ID - Type Unspecified