Provider Demographics
NPI:1396825329
Name:ANDRADE, TERRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
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:PO BOX 520
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0520
Mailing Address - Country:US
Mailing Address - Phone:256-492-6760
Mailing Address - Fax:256-492-6762
Practice Address - Street 1:300 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 302
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1157
Practice Address - Country:US
Practice Address - Phone:256-492-6760
Practice Address - Fax:256-492-6762
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL23039OtherUNITED HEALTHCARE
AL051023039OtherBCBS
AL051521568OtherBCBS
AL009983865Medicaid
AL000023039Medicaid
AL23039OtherTRICARE
AL23039OtherUNITED HEALTHCARE
AL000023039Medicaid