Provider Demographics
NPI:1356330252
Name:ANDRADE, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ANDRADE
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 1:5412 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8522
Mailing Address - Country:US
Mailing Address - Phone:407-658-7882
Mailing Address - Fax:407-656-7995
Practice Address - Street 1:5412 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8522
Practice Address - Country:US
Practice Address - Phone:407-658-7882
Practice Address - Fax:407-656-7995
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049328207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2000213OtherGHI
FL9274OtherAVMED
FL201227OtherAMERIGROUP
FL378451700Medicaid
FL18251OtherHEALTHEASE
FL142941OtherONE HEALTH PLAN
FL47817071008OtherCIGNA
FL624969OtherAETNA
FL201227OtherAMERIGROUP