Provider Demographics
NPI:1518259902
Name:ANDRADE, ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
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 1:2121 PEASE ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8348
Mailing Address - Country:US
Mailing Address - Phone:956-389-6565
Mailing Address - Fax:956-389-6567
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8348
Practice Address - Country:US
Practice Address - Phone:956-389-6565
Practice Address - Fax:956-389-6567
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0401207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ0401OtherMEDICAL LICENSE