Provider Demographics
NPI:1275689655
Name:SEGAL, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SEGAL
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 1:801 ROAD TO SIX FLAGS W STE 123
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2615
Mailing Address - Country:US
Mailing Address - Phone:817-261-7300
Mailing Address - Fax:817-861-2004
Practice Address - Street 1:801 ROAD TO SIX FLAGS W
Practice Address - Street 2:STE 123
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2616
Practice Address - Country:US
Practice Address - Phone:817-261-7300
Practice Address - Fax:817-861-2004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1144263-02Medicaid
TXD762OtherBLUE CROSS
TXD762OtherBLUE CROSS
TX1144263-02Medicaid