Provider Demographics
NPI:1083624241
Name:ALANDY, ANTONIO MORA (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MORA
Last Name:ALANDY
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:SD
Mailing Address - Zip Code:57437-0037
Mailing Address - Country:US
Mailing Address - Phone:605-284-2342
Mailing Address - Fax:605-284-2227
Practice Address - Street 1:200 J AVE STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:SD
Practice Address - Zip Code:57437-2225
Practice Address - Country:US
Practice Address - Phone:605-284-2621
Practice Address - Fax:605-284-2623
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5608080Medicaid
SD5608080Medicaid
E62402Medicare UPIN