Provider Demographics
NPI:1275685521
Name:ANDRADE, OSCAR ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ERNESTO
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:AZ
Mailing Address - Zip Code:85532-1508
Mailing Address - Country:US
Mailing Address - Phone:928-402-0952
Mailing Address - Fax:928-425-7566
Practice Address - Street 1:108 SOUTH BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-425-6592
Practice Address - Fax:928-425-7566
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1275685521OtherNPI TYPE I OSCAR ANDRADE
AZZ71801OtherPTAN OSCAR ANDRADE
AZ1205962792OtherNPI TYPE II MEDCOM MEDICAL LLC
AZZ71760OtherPTAN MEDCOM MEDICAL, LLC
AZ475592Medicaid
AZ475592Medicaid
AZ475592Medicaid