Provider Demographics
NPI:1568427714
Name:DESIRE, ANDRE POTHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:POTHEL
Last Name:DESIRE
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 1:1631 11TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4320
Mailing Address - Country:US
Mailing Address - Phone:940-687-5000
Mailing Address - Fax:940-687-4000
Practice Address - Street 1:1631 11TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4320
Practice Address - Country:US
Practice Address - Phone:940-687-5000
Practice Address - Fax:940-687-4000
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5899207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037928103Medicaid
TXF12208Medicare UPIN
TX8D2545Medicare ID - Type Unspecified