Provider Demographics
NPI:1265486781
Name:PARTAL, ANDREEA EVELIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREEA
Middle Name:EVELIN
Last Name:PARTAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E TICKLE ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3163
Mailing Address - Country:US
Mailing Address - Phone:731-286-2801
Mailing Address - Fax:731-286-0058
Practice Address - Street 1:401 E TICKLE ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3163
Practice Address - Country:US
Practice Address - Phone:731-286-2801
Practice Address - Fax:731-286-0058
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723242Medicaid
TN1018449OtherOMNICARE
TN168490OtherBETTER HEALTH
TN4109612OtherBLUE CROSS
TN35073OtherTLC
TN35073OtherTLC
TN168490OtherBETTER HEALTH